Systems and methods for surfacing contextually relevant content into the workflow of a third party system via a distributed architecture

ABSTRACT

Systems and methods for surfacing contextually relevant data into the workflow of a third party system are discussed herein. The system implements a near-real-time method of detecting activity corresponding to particular electronic health records associated with particular patients in third-party systems using specifically configured software systems. A cloud-based micro-services architecture is communicably coupled to the third-party systems and is operable to transmit contextually relevant data to the third-party system in response to particular detected activities, such as accessing a patient&#39;s electronic health record. The contextually-relevant data is identified by comparing electronic health record data from various third-party systems, each third-party system associated with the particular patient, to determine gaps in the records. The contextually relevant data is transmitted to the third-party system and visually integrated into the third-party system&#39;s pre-existing clinical workflow.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Continuation patent application of, and claims thebenefit of and priority to, U.S. Non-Provisional patent application Ser.No. 15/796,391, filed on Oct. 27, 2017, and entitled “SYSTEMS ANDMETHODS FOR SURFACING CONTEXTUALLY RELEVANT CONTENT INTO THE WORKFLOW OFA THIRD PARTY SYSTEM VIA A DISTRIBUTED ARCHITECTURE,” which is aNon-Provisional patent application of, and claims the benefit of andpriority to, U.S. Provisional Patent Application No. 62/413,615, filedon Oct. 27, 2016 and entitled “SYSTEMS AND METHODS FOR SURFACINGCONTEXTUALLY RELEVANT CONTENT INTO THE WORKFLOW OF A THIRD PARTYSYSTEM,” the disclosures of which are incorporated by reference in theirentireties as if the same were fully set forth herein.

TECHNICAL FIELD

The present disclosure relates generally to surfacing electronic healthrecord data into third-party workflows using a unique computer hardwarearchitecture and software.

BACKGROUND

In 2009, legislation was enacted establishing the Office of the NationalCoordinator (ONC) to carry out the directives contained in the AmericanRecovery and Reinvestment Act (ARRA) and the Health InformationTechnology for Economic and Clinical Health (HITECH) Act, which aimed atincentivizing provider organizations to adopt and implement newhealthcare technologies called Electronic Medical Record (EMR) systemsto better manage overall patient care as a response to a lack oftechnology adoption in previous years. As of 2011, Electronic HealthRecord (EHR) systems, as defined by the Centers for Medicare andMedicaid Services (CMS) as being required for Meaningful Use (MU) inorder for Eligible Providers (EP) to receive incentive payments tied tocare coordination, are at last becoming more widely adopted.

Meanwhile, other risk-based incentive programs, focusing on qualityoutcomes for populations, are gaining traction from an ever-changinglandscape of market participants such as private insurance companiesseeking to supplement Medicare beneficiary risk mitigation as a responseto the Affordable Care Act (ACA) enacted by the federal government onMar. 23, 2010. As part of this evolution, the U.S. federal governmenthas committed to those privately held insurance companies, in what hascome to be known as the Medicare Advantage (MA) program, that if thequality of care improves while the cost of care is lowered all whilekeeping patient satisfaction levels high (i.e. the Triple AIM), greaterincentive payments shall be awarded while Medicare beneficiaries areunder their management and control as weighted against a quality ratingmeasurement scale known as the “Five-Star Quality Rating System.” Thegoal of this CMS-defined quality rating system is to measure a Medicarebeneficiaries' experience with their health plans and the health caresystem overall. This recent evolution has driven many private insurancecompanies to advance their employment of analytic strategies acrosstheir networks in an effort to gain greater efficiencies related tochronic care management as well as risk mitigation practices. In turn,the correlation of EHR-generated patient data married to health plananalytic membership data optimizes the opportunity for the ACA to have agreater impact on overall population health outcomes.

In response to these changes in administrative incentive payments,private insurers have positioned themselves to becoming more tightlyaffiliated with their enrolled members' EPs as they now have a drivingforce to better balance membership risk to incentive payments, as thatties to both health plan and EP revenues. This has led to the rise of apayment distribution arrangement whereby the insurance plan may sharecertain incentive payments or savings with partnering clinical entitiesknown as Accountable Care Organizations (ACO) in what has been termed aMedicare Shared Savings Plan (MSSP) created in 2011 by the federalgovernment's Health and Human Services (HHS) division. In thesearrangements, the insurance company may incentivize primary carephysicians for better communicating the risk of a plan member undertheir care. This is called a Medicare Risk Adjustment and is a coreconcept in many risk reduction programs.

In 2015, the most common risk adjustment method used in MA riskreduction programs is a manual chart audit. This audit is typicallyconducted by a private insurer's employee who has been deployed onsiteto capture and collect all the clinical documentation necessary tobolster a private insurer's ability to appropriately assess a member'soverall risk such that the member may be categorized into suitablestratified risk panels thereafter. In other cases, providers havelobbied to be allowed to risk adjust their own patients without manualchart audit intervention. However, prior to these events, CMS createdwhat are known as Hierarchical Conditional Codes (HCC) in 2004 to assistprivate insurers with the risk stratification process when adjustingbundled incentive payments (e.g. capitation payments) for the monetaryexpenditure of their members/enrollees. Therefore, in order for theproviders to get what they have lobbied for, insurance companies mayneed to find a way to support not only risk identification via anelectronic medium, but also empower providers to capture HCC on theirown at the time of risk adjustment. To combat this challenge, electronicweb portals were developed to enable providers an electronic way ofsupplying risk adjustment data to health plans in order to qualify fortheir shared savings incentives. This requires immense documentation ofclinical activity external to the provider's workflow, whichunfortunately is a time-consuming effort that replicates data that haslikely already been captured within an EHR system. Additionally, EHRsystems are generally “closed,” so the data stored therein cannot beeasily accessed.

Therefore, there is a long-felt but unresolved need for a system ormethod that: a) more efficiently collects and analyzes data by reducingdata collection time and replication; b) connects disparate systems viaa novel computer architecture; c) improves existing EHR computersystems; and d) interacts seamlessly with provider EHR systems andinsurance company data analytics systems to support Medicare riskreduction programs in an effort to improve the overall course of carefor patients and better health outcomes for populations.

BRIEF SUMMARY OF THE DISCLOSURE

Briefly described, and according to one embodiment, aspects of thepresent disclosure generally relate to systems and methods for providingcontextually relevant content sourced from third party analytics systemsto be surfaced within the current workflow of a separate third partysystem, particularly healthcare specific clinical and financial systems.A technical solution including an Insights Application (IA), asdescribed herein, enables organizations such as insurance companies andother population health analytics entities (Sponsoring Organization, orSponsors) to promote their analytic content, as calculated by theirproprietary analytics algorithms and published by their proprietaryanalytic platforms, to healthcare providers (Partner Organization, orPartners) within the workflow of the third party systems to which thehealthcare providers use. The content is generally targeted to specificpersons (patients) who fall within certain predefined inclusionarycriterion such as being an enrollee of a Sponsor's (e.g. insurancecompany) health plan or by being a member of a Sponsor's (e.g. ACO)membership. Generally, the IA has awareness of a patient record (chart)open in the third party system and surfaces content such as an IAsummary message to the end user in the form of a non-intrusive, smallnew window on the user's screen that conveys a summary of applicablecontent for that member. By design, this “alert” may appear on top ofother screen content on the user's computer workstation monitor. Thedefault location of this alert may be the upper right hand corner of thescreen, but may be repositioned at any time and saved as a userpreference. The content of such an alert may include, but is not limitedto, information related to the patient as having been enrolled in anACO, the patient having outstanding gaps in their overall care (asmeasured annually by CMS for MA patients), or any other alertspertaining to the current and/or previous financial coding conducted forbilling purposes for submittal to the Sponsoring Organization. Thesecoding gaps become risk adjustment opportunities thereafter aspreviously described. The alert, once clicked, may disappear from thescreen and an IA details view may slide into view from the right. Thisis the primary view of the IA and provides much greater detailsurrounding the content as summarized in the alert and gives greatercontrol to the Partner Organization's end user to supply additionalinformation back to the Sponsoring Organization via the IA.

According to one aspect, the system offers a context-sensing system(Context Sensor, or Sensor) driven by configurable templates to create asensory ability, wherein each Sensor operates independently from the IAas well as not requiring participation of the third party system vendor.In most circumstances, all that may be needed for proper implementationis assistance from the local Partner's (i.e. physician's office)information technology resources staff. Generally, operation of theSensor matches specific person identifiers as sourced by both parties(system one person data to system two person data) and correlates thecommon identity prior to promoting this correlation as a commonidentifier to a micro-services application programming interface (API)known as Hive.

More particularly described, aspects of the present disclosure relate toa system for correlating third party user and patient identifiers torelated Sponsor identifiers. This provides a mechanism to sense themoment in time a user of a third party system brings patient data intofocus (e.g. opens a chart) and determines if any external content existsabout that patient such that the IA may in near real-time present analert to the Partner's end user.

These and other aspects, features, and benefits of the claimedinvention(s) will become apparent from the following detailed writtendescription of the preferred embodiments and aspects taken inconjunction with the following drawings, although variations andmodifications thereto may be effected without departing from the spiritand scope of the novel concepts of the disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings illustrate one or more embodiments and/oraspects of the disclosure and, together with the written description,serve to explain the principles of the disclosure. Wherever possible,the same reference numbers are used throughout the drawings to refer tothe same or like elements of an embodiment, and wherein:

FIG. 1 is an exemplary high-level overview of a Medicare Advantage riskreduction program, according to one aspect of the present disclosure;

FIG. 2 is an exemplary high-level overview of an operationalenvironment, according to one aspect of the present disclosure;

FIG. 3 is a high-level overview of the exemplary system architecture,according to one aspect of the present disclosure;

FIG. 4 is a diagram illustrating a cloud-based micro-servicesarchitecture, according to one aspect of the present disclosure;

FIG. 5 is a diagram illustrating an application architecture, accordingto one aspect of the present disclosure;

FIG. 6 is a diagram illustrating a sensor architecture, according to oneaspect of the present disclosure;

FIG. 7 is a sequence diagram illustrating a data provisioning process,according to one aspect of the present disclosure;

FIG. 8 is a sequence diagram illustrating an organization and userprovisioning process, according to one aspect of the present disclosure;

FIG. 9 is a sequence diagram illustrating a membership attestation andexemplary identity matching process, according to one aspect of thepresent disclosure;

FIG. 10 is a sequence diagram illustrating a remote system contextcontrol process, according to one aspect of the present disclosure;

FIG. 11 is a sequence diagram illustrating a context sensitive alert anddata presentation process, according to one aspect of the presentdisclosure;

FIG. 12 is a flowchart illustrating an exemplary code gap detectionprocess, according to one aspect of the present disclosure;

FIG. 13 is an exemplary illustration of code gaps in a data structure,according to one aspect of the present disclosure;

FIG. 14 is a high-level illustration of identity management betweenexternal paired systems, according to one aspect of the presentdisclosure;

FIG. 15 is a flowchart of the exemplary identity management process,according to one aspect of the present disclosure;

FIG. 16 is a diagram illustrating cross-platform identificationmatching, according to one aspect of the present disclosure;

FIG. 17 is a flowchart of the exemplary follow and patient process,according to one aspect of the present disclosure;

FIG. 18 is a flowchart of the exemplary task automation process,according to one aspect of the present disclosure;

FIG. 19 is a diagram illustrating an exemplary data exporting process,according to one aspect of the present disclosure;

FIG. 20 is a flowchart of an exemplary application context surfacingdecision tree, according to one aspect of the present disclosure;

FIG. 21 is an exemplary application tab feature, according to one aspectof the present disclosure;

FIG. 22 is an exemplary sign-in pane application feature, according toone aspect of the present disclosure;

FIG. 23 is an exemplary password pane application feature, according toone aspect of the present disclosure;

FIG. 24 is an exemplary pop-up alert application feature, according toone aspect of the present disclosure;

FIG. 25 is an exemplary coding gap pane application feature, accordingto one aspect of the present disclosure;

FIG. 26 is an exemplary user profile pane application feature, accordingto one aspect of the present disclosure;

FIG. 27 is an exemplary eligibility summary pane application feature,according to one aspect of the present disclosure;

FIG. 28 is an exemplary schedule pane application feature, according toone aspect of the present disclosure; and

FIG. 29 is a record activity pane application feature, according to oneaspect of the present disclosure.

DEFINITIONS

Prior to a detailed description of the disclosure, the followingdefinitions are provided as an aid to understanding the subject matterand terminology of aspects of the present systems and methods, areexemplary, and not necessarily limiting of the aspects of the systemsand methods, which are expressed in the claims. Whether or not a term iscapitalized is not considered definitive or limiting of the meaning of aterm. As used in this document, a capitalized term shall have the samemeaning as an uncapitalized term, unless the context of the usagespecifically indicates that a more restrictive meaning for thecapitalized term is intended. However, the capitalization or lackthereof within the remainder of this document is not intended to benecessarily limiting unless the context clearly indicates that suchlimitation is intended.

1. Electronic Health Record (EHR): In one embodiment, an electronichealth record may include health related information pertaining to aparticular individual, which may be stored and shared digitally.Electronic health and medical records may include information such asname, date of birth, gender, age, Medicare beneficiary identifiers,surgical history, prescriptions, allergies, various health conditions,etc. The term “EHR” may be defined by the Centers for Medicare andMedicaid Services (CMS), and said EHR systems are contemplated herein,but the definition of EHR in this document is not limited to the CMSdefinition of the same.

2. Sponsor Organization: In various embodiments, a Sponsor Organization,or Sponsor, may be a healthcare insurance provider, a Managed ServicesOrganization (MSO), an Accountable Care Organization (ACO), a healthcareclaims clearinghouse or similar organization that may provide insurancepolicies to individuals or other services to healthcare providers.

3. Partner Organization: In one embodiment, a Partner Organization, orPartner, may be a healthcare provider/establishment such as a hospitalor clinic.

4. Insights Application (IA): In one embodiment, a softwareconfiguration within the computing system of a Partner that allowscontent such as contextually relevant information to be surfaced into athird party work flow such as an EHR. In various embodiments, the IAruns one or more additional software applications/processes. In certainembodiments, these applications provide alerts to the user of thecomputing system operatively hosting the IA, and then further provideadditional detailed information regarding the content if the alert isselected. In one embodiment, the information regarding these alerts issent to the IA from Hive in response to the applicability of the patientin focus (e.g. user opens patient chart), determined by the ContextSensor querying the third party system.

5. Holon Connect Engine: In one embodiment, a software configurationincluded in Hive. According to aspects of the present disclosure, theHolon Connect Engine operates within Hive and receives Sponsormembership data from a Sponsor's Common Data Access Point (CDAP).

6. Context Sensor (or sensor): A general name given to a softwareconfiguration for sensing a triggering event via various mechanismsdiscussed herein. Upon sensing a triggering event, the Sensor may send,retrieve, request, and/or transmit information to another system, suchas Hive or take some other action. In particular embodiments, a Sensoris operatively connected to a third party system and may be grantedaccess to electronic health records, or may be configured to monitorcertain electronic health records that are actively opened on aprovider's screen (where opening of an electronic health record is atriggering event). As will be understood from discussions herein, thesystem may include more than one Sensor. In general, the Sensor isconfigured to monitor the activity within the third party system andtrigger various actions based on activity regarding individuals orparticular aspects of a set of information provided by the Sponsor.

7. Hive: In one embodiment, a proprietary term for a cloud basedmicro-services architecture that includes multiple databases and webservers configured to map user identifications as well as associatecertain trigger events with a corresponding action. Hive may beconfigured to match and associate particular individuals across variousorganizations, such as individuals that visit more than one doctor. Hivemay process large data sets, such as a Sponsor's membership list, intoan appropriate format. In certain embodiments, Hive processes and storesdata as received from a Sponsor and acts as the storage faculty for allinbound and outbound data requests as originated by the IA or Sensor.

8. CollaborNet: In various embodiments, a proprietary name for acombination of services including Hive as well as software servicesdeployed on a client's systems, namely the IA and Sensor. It should beunderstood from the discussion herein that CollaborNet is, in at leastone embodiment, a configuration of software and/or hardware that createsa secure network that manages the assembly, packaging, routing, anddelivery of healthcare information among and between care deliveryorganizations, namely Sponsor Organizations and Partner Organizations.CollaborNet may monitor and/or receive data from one or more sources,catalogs contextual information from those systems, and then utilizecontent in focus in the third party system (e.g. patient or scheduleinformation in an EHR) to display content corresponding to informationsourced from the aforementioned systems.

9. Common Data Access Point (or CDAP): In one embodiment, a location ormemory address within a computing system wherein particular data isstored and made available to various third party computing systems (i.e.REST API, or sFTP location). According to aspects of the presentdisclosure, the CDAP is accessible by both the Sponsor Organization andthe Holon Connect Engine of Hive.

DETAILED DESCRIPTION OF FIGURES Overview

For the purpose of promoting an understanding of the principles of thepresent disclosure, reference will now be made to the embodimentsillustrated in the drawings and specific language will be used todescribe the same. It will, nevertheless, be understood that nolimitation of the scope of the disclosure is thereby intended; anyalterations and further modifications of the described of illustratedembodiments, and any further applications of the principles of thedisclosure as illustrated therein are contemplated as would normallyoccur to one skilled in the art to which the disclosure related. Alllimitations of scope should be determined in accordance with and asexpressed in the claims.

Aspects of the present disclosure generally relate to systems andmethods for efficiently providing third-party data over computernetworks, improving database systems to increase speed of delivery ofsuch data and quality of third-party clinical and financial informationthrough novel computer injection mechanisms. Further aspects of thepresent systems and methods relate to providing contextually relevantcontent sourced from third-party analytics systems to be surfaced withinthe current workflow of a separate third party system, particularlyhealthcare specific clinical and financial systems.

The healthcare information technology industry supports satisfyingmandates and policies set forth by the federal government with regard tohealthcare. Generally, private insurance companies have assumed the taskof providing health care insurance to the population. These privatecompanies have promised better results in all aspects of the triple-AIM(better quality/experience of care, better population health, lower costof care per capita) as measured and rated on a Five-Star basis by CMS,in return for greater financial incentives when underwriting risk forMedicare patients in what has come to be known as Medicare Advantageplans. In some cases, a half-star rating increase may be valued at$30-million in revenue for a membership of 50,000 Medicare members.These private companies earn their star ratings based on a formula thatincorporates various information such as information provided by doctorsand patient satisfaction. In many scenarios, when a person files aninsurance claim through a health clinic or another establishment thataccepts health insurance, the claim is processed through an automaticclearing-house (ACH). In some scenarios, the entire process ofadjudicating a claim, receiving payment/reimbursement, reporting thedelivered care, as well as receiving other relevant informationregarding the patient and their adjusted risk from the private companymay take upwards of 90 days.

Aspects of the present disclosure solve the above problem with atechnical solution, namely providing a distributed architecture systemat least allowing for additional content and information related to thedelivery of care as well as any outstanding gaps in care to be surfacedwithin the workflow of an electronic health record at the point and timeof care, thus representing an improvement on delivery of the informationregarding the patient and their adjusted risk taking upwards of 90 days.

Medicare Advantage—Exemplary System Aspects

Referring now to the figures, for the purposes of example andexplanations of the processes and components of the disclosed systemsand methods, reference is made to FIG. 1, which illustrates anexemplary, high-level overview of a Medicare Advantage risk reductionprogram, according to one embodiment. As will be understood andappreciated, the conceptual overview shown in FIG. 1 represents merelyone approach or embodiment of the present systems, and other aspects areused according to various embodiments of the present system. Included inthe present embodiment is a representation of the U.S. government 102,insurance companies 104A and 104B, a hospital 106, and clinics 108A,108B, and 108C. Distributed throughout these elements are patients 110A,110B, and 110C. The description below is an overview of the exemplaryprocess of a Medicare Advantage risk reduction program and describes howthe above-mentioned elements may correspond to the process.

In one embodiment, the U.S. government 102 oversees a Medicare Advantagerisk reduction program as well as the Medicare Advantage reimbursementprogram, which patients 110A, 110B, and 110C are enrolled in. In thepresent embodiment, the U.S. government 102 has assigned certainresponsibilities under the Medicare Advantage reimbursement program toprivate insurance companies 104A and 104B. In various embodiments, andin return for ensuring high quality of care for a relatively low price,the U.S. government 102 may reward insurance companies 104A and 104Bwith monetary compensation. In a particular embodiment, when patient110B visits clinic 108A, as shown in FIG. 1, the clinic 108A will file aclaim with insurance company 104A with which patient 110B is enrolled.Continuing with this embodiment, the clinic 108A will also report themedical record and a risk adjustment if necessary. In this embodiment,reporting a risk adjustment to insurance company 104A may allow forinsurance company 104A to reevaluate how patient 110B is insured inorder to offer them more appropriate coverage. In return for reportingthe medical record, the risk adjustment information, and the claims ofservices rendered, insurance company 104A, in this embodiment, willcompensate clinic 108A at a higher rate for the services provided topatient 110B should there be sufficient evidence supporting patient 110Bas having greater risk than previously documented.

According to various aspects of the present disclosure, the informationsuch as the medical record, risk adjustment information, and claimsprovided by the clinic 108A, can be used by insurance company 104A inorder to prove to the U.S. government 102 that quality care is beingprovided to these members. As a result, the U.S. government 102 mayreward insurance company 104A by increasing insurance company 104A'sCMS's Five-Star quality rating, which will result in largerreimbursements for insurance company 104A going forward.

Continuing with FIG. 1, patient 110A may visit both the hospital 106 andclinic 108B. In this scenario, and according to one embodiment, both thehospital 106 and clinic 108B may file a claim with insurance company104A with which patient 110A is enrolled. Both the hospital 106 andclinic 108B may also report the medical record and a risk adjustment ifnecessary. Also illustrated in FIG. 1, patient 110C may visit both thehospital 106 and clinic 108C. In this scenario, and according to variousembodiments, both the hospital 106 and clinic 108C may file a claim withinsurance company 104B and also may report the medical record and a riskadjustment if necessary. Generally, a particular patient may visit morethan one doctor or healthcare provider over a period of time for variousreasons. In some scenarios, a particular patient may have a primaryphysician but due to a medical emergency is treated at a hospital.Similar to the example above regarding patient 110B, reporting claims,medical records, and risk adjustments back to insurance companies allowsfor the insurance companies to compensate for claims at a higher rate,reevaluate appropriate insurance coverage based on health and risk, andto allow for potential Five-Star rating adjustments in turn, yieldinggreater reimbursement payments from CMS. According to various aspects ofthe present disclosure, detecting code gaps in electronic heath recordsallows for the system to further identify areas for risk adjustment, aswell as improved care, therefore providing the compensation benefit tothe reporting healthcare provider.

Exemplary Closed Loop System Analytics

Turning now to FIG. 2, an exemplary high-level overview of anoperational environment 200 is illustrated in accordance with variousaspects of the present disclosure. According to various aspects of thepresent disclosure, the embodiment shown in FIG. 2 illustrates animproved distributed architecture system for distributing information toand from normally closed systems, generally for augmenting thepresentation of electronic health records with surfaced third partycontent in order to improve the completeness and accuracy of healthinformation presented to providers at the point and time of care. Alsoillustrated in FIG. 2 is a timely mechanism for a Partner to submithealth record data back to a Sponsor. As will be understood andappreciated, the conceptual overview shown in FIG. 2 represents merelyone approach or embodiment of the present system, and other aspects areused according to various embodiments of the present system.

In one embodiment, the system 200 includes at least a Sponsor 202 (e.g.payer/insurance company), a Partner 204 (e.g. ambulatory health clinic),a micro-services cloud infrastructure 206 (including the combination ofHive and the Holon Connect Engine), a Common Data Access Point (CDAP)208, an Insights Application (IA) 210 within the Partner environment204, an analytic system 212 within the Sponsor environment 202, and aSensor 214 operatively connected to the EHR system 226 within thePartner environment 204. In various embodiments, the Sponsororganization 202 and the Partner organization 204 are in operablecommunication over any suitable network (e.g., wired network, wirelessLAN, CollaborNet, etc.).

For the purpose of describing the present embodiment, consider threescenarios (Scenarios A, B, and C), each scenario involving a patiententering a doctor's office (Partner organization 204) for a medicalexamination. In Scenario A, the particular patient is a repeat patientand the Partner organization 204 maintains an electronic health recordfor the patient. In response to the doctor opening the patient'selectronic medical record, a light-weight software configurationreferred to herein as the sensor queries the cloud-based micro-servicessystem 206 for any healthcare data associated with the patient. Invarious embodiments, included in the query to the cloud-basedmicro-services system 206 is at least a portion of chart data 216 and apatient identifier. In one embodiment, the cloud-based micro-servicessystem 206 is operable to retrieve any corresponding health recordsrelating to the particular patient and further compare the portion ofchart data 216 to any data stored in the cloud-based micro-servicessystem 206. In particular embodiments, comparing the data may exposegaps in healthcare data or coding. According to various aspects of thepresent disclosure, these exposed gaps 228 are transmitted to theInsights Application 210 at the doctor's office and are furtherpresented to the doctor in the form of an alert, pop-up or slide outbar, notification, etc. Providing the doctor with information relatingto gaps on care or coding allows for the doctors to provide the mostinformed care possible while also achieving other advantages such assaving costs during the process of filing Medicare claims.

In Scenario B, and according to one embodiment, consider that thepatient enters the doctor's office (e.g., Partner 204) and is afirst-time patient. In various embodiments, prior to administeringtreatment to this patient, the doctor may collect information from thepatient such as name, date of birth, social security number, medicalinsurance information, etc. Furthermore, the doctor may enter thisinformation into his/her respective EHR/electronic medical record system226 and proceed with treating the patient. According to various aspectsof the present disclosure, installed on the doctor's computer system arethe Sensor 214 and Insights Application 210 as described herein. As aresult of providing care to the patient, the Sensor 214 transmits aclinical summary and other relevant treatment information to thecloud-based micro-services system 206. In a particular embodiment, inresponse to receiving this data, the cloud-based micro-services system206 determines other doctors (or healthcare organizations of interest)that are associated with the particular patient and further notifies theother associated doctors or providers of the recently provided care.

In Scenario C, consider the patient is a repeat patient at the doctor'soffice (e.g., Partner 204) and the doctor begins to prescribe thepatient a new drug. According to various aspects of the presentdisclosure, the action of prescribing a new drug may be a preconfiguredtrigger event (detected by Sensor 214) that results in the systemautomatically executing a series of tasks. For example, and in responseto detecting the trigger event, the system may determine if thepatient's insurance is included in a list of excluded insurances,presenting an alert to the doctor if the patient's insurance will notcover the cost of the drug, and if the patient's insurance will coverthe cost of the drug further automatically populating the prescriptioninformation.

In various embodiments and prior to each of the above three scenarios(or after), the cloud-based micro-services system 206 may receive memberdata 218 from the analytic system 212 of the Sponsor 202. According tovarious aspects of the present disclosure, the member data 218 mayinclude a list of Medicare beneficiaries (e.g., “member list”). In someembodiments, a member list may include relevant information such asname, gender, date of birth, age, Medicare beneficiary identification,primary care provider information, gaps in clinical care, gaps in claimssubmission and coding, MSSP/MSO/ACO identifiers, etc. relating to theparticular patients included in the member list. In a particularembodiment, the information contained in the member list may not beincluded in an electronic health record. In some embodiments, furtherinformation may include information pertinent to the Partner 204 at thetime of care, which may be presented at this time.

In one embodiment, the Sponsor 202 includes a firewall (or anotherappropriate data protection mechanism) for protecting the member data218 included in the analytic system 212. According to various aspects ofthe present disclosure, the member data 218 may be pushed to the CommonData Access Point 208 where the cloud-based micro-services system 206may retrieve the member data 218 via the Holon Connect Engine 224.

In various embodiments, the system components included in the threescenarios above are described in further detail below, and the role ofeach component will be described accordingly.

In one embodiment, the Sponsor 202 is a payer or insurance company. Insome cases, Sponsors 202 provide a service to a group of enrolledmembers. In the present embodiment, the Sponsor 202 provides healthinsurance to individuals enrolled in various health care plans. In oneembodiment, analytic information (e.g., member data 218) regarding theseindividuals is stored in a database (e.g., analytic system 212) includedwithin the computing systems of the Sponsor 202. Generally, member data218 includes various information (e.g., name, gender, date of birth,age, primary care provider NPI, Medicare beneficiary identifier, etc.)regarding the individuals enrolled in a Sponsor 202's services will alsobe stored in the analytic system 212. As will be understood fromdiscussions herein, the Sponsor 202 may perform any suitable dataanalytics associated with the quality of care provided, the coding ofcare delivered, patient outcomes, patient satisfaction, health records,etc.

In particular embodiments, and mentioned briefly above, the Sponsor202's system may include a firewall to protect patient information(firewall not shown). Due to this firewall, the Sponsor 202 may push themember data 218 to a Common Data Access Point (CDAP) 208, outside thegeneral firewall to be accessed by a connection engine 224 (e.g., HolonConnect Engine) included in the cloud-based micro-services system 206 toallow the cloud-based micro-services system 206 to retrieve or otherwiseaccess the member data 218 (and/or other relevant data).

In one embodiment, the Partner 204 is a hospital or health clinic.Typically, Partners 204 provide a service to individuals on acase-by-case basis (e.g., a doctor provides medical treatment and adviceto patients by appointment). In one embodiment, a Partner 204 may have abusiness relationship with a Sponsor 202 wherein the Sponsor 202reimburses the Partner 204 for various provided services (e.g., throughMedicare). In the present embodiment, this reimbursement for services isillustrated by the back and forth transaction of Medicare claims 220 andMedicare reimbursements 222 (although the system may be applicable toinformation and/or insurance other than Medicare).

In various embodiments, a patient may receive care from the Partner 204and the Partner 204 may then file a claim 220 to the Sponsor 202(insurance company) associated with the particular patient requestingreimbursement for the care provided. In one embodiment, the Sponsor 202will process and approve the claim 220, assuming that the patient isenrolled in a plan with the Sponsor 202, and the Sponsor 202 will thensend a reimbursement 222 to the Partner 204.

As mentioned above and according to one embodiment, a Common Data AccessPoint 208, or CDAP, may be a location within a computing system,computing network, or the like, where a particular set of information ispushed, transmitted, or stored in order to allow access to theinformation by third parties (e.g., through a suitable API, SSH tunnel,or the like). In the present embodiment, the member list/member data 218including the enrolled members of a Sponsor's 202 service is transmittedto the CDAP 208, along with any other additional files or analyticinformation relevant to the overall care or plan information of themembership, in order for the cloud-based micro-services system 206 toaccess the data.

As will be understood from discussions herein, the Sponsor 202 maytransmit data, such as member data 218, to the CDAP 208 at regularintervals and/or substantially constantly upon receiving newinformation. In one embodiment, the Sponsor 202 updates and transmitsinformation to the CDAP 208 approximately every thirty days. In someembodiments, the Sponsor 202 updates and transmits information to theCDAP 208 in varying frequencies such as every day, every 7 days, every60 days, etc.

In one embodiment, cloud-based micro-services system 206, also referredto herein as Hive, may be a web based server cluster or computing systemthat is configured to process and store large amounts of information,and distribute the information to other computing systems.

In the present embodiment, Hive 206 is configured to periodically pullthe member list and member data 218 from the CDAP 208 and process itinto a non-relational format that is normalized and appropriate to bedistributed within the system. In various embodiments, Hive 206communicates this processed information to the IA 210, which may thenpresent this information to a user of the present system (e.g., careprovider, doctor, etc.) in the form of a surfaced content summary alert.

In one embodiment, the Insights application (IA) 210 is a softwareconfiguration within the Partner environment 204, which allowscontextually relevant information to be surfaced into a third partyworkflow. In particular embodiments, the IA 204 represents two softwareapplications: 1) an application that provides alerts including summaryinformation from Hive, as sourced from the Sponsor 202, to the computingsystem of the Partner 204, and; 2) an application that presents a largerset of information if the alert is selected by the Partner 204 user andprovides further information and functionality, such as a mechanism forelectronic communication between the Partner 204 and the Sponsor 202(e.g., via Hive 206). In certain embodiments, an alert is a notificationto the Partner 204 produced by Hive 206 based on the informationreceived by the Sensor 214 and the information from the Sponsor 202 thatthe patient may have certain care gaps that need to be addressed.

For example, the individual may be in the Partner's office 204 forissues relating to a fever, but upon opening up the individual'selectronic health record the doctor may be alerted by the IA 210 thatthe individual has shown gradual increase in blood pressure over thepast five years and should be evaluated for hypertension, especially ifthe individual has not been seen in over a year. In various embodiments,the information regarding the past five years of blood pressure readingsmay be included in the electronic health record or included in data fromHive 206 that has been acquired and normalized from the Sponsor 202. Inone embodiment, Hive 206 is configured to determine relationshipsbetween patient identities across disparate Partners 204 and can surfacecare alerts via the IA 210 as sourced from Sponsors 202 to theirindividual Partners 204.

In one embodiment, the Sensor 214 is a software configuration (e.g.,software service, plug-in, backend code, etc.) for sensing a triggeringevent via various mechanisms discussed herein. Upon sensing a triggeringevent, the Sensor 214 may send, retrieve, request, and/or transmitinformation to another system, such as Hive 206. In particularembodiments, a Sensor 214 is operatively connected to a Partner system204 and may be granted access to electronic health records, or may beconfigured to monitor certain electronic health records that areactively opened on a provider's screen (where opening of an electronichealth record is a triggering event). As will be understood from thediscussions herein, the system may include more than one Sensor 214. Inparticular embodiments, the system includes a first Sensor 214operatively connected to a provider system (e.g., a Partner 204) and asecond Sensor configured to operate as the connection engine 224 (e.g.,Holon Connect Engine) operatively connected to the cloud-basedmicro-services system 206, wherein the role of the second Sensorincludes transmitting and receiving data (member data 218) from a CDAP208. In general, the Sensor 214 is configured to monitor the activitywithin the exemplary system and trigger various actions based onactivity regarding patients or particular aspects of a set ofinformation provided by the Sponsor. According to various aspects of thepresent disclosure, the Sensor 214 may have an operative connection toHive 206 in order to send, retrieve, and/or transmit informationregarding a trigger event, such as an accessed electronic health record.In particular embodiments, examples of trigger events may include eventssuch as a user opening a patient's electronic medical record, a userbeginning an order workflow (e.g., ordering a prescription), a usercreating a new chart, a user signing an encounter note, etc. Inparticular embodiments, a trigger event includes intercepting anapplication programming interface call for reading, writing to, orretrieving a particular electronic health record, detecting manipulationof a particular electronic health record at the EHR system 226, ordetecting a particular electronic health record being presented on adisplay. In various embodiments, detecting a particular electronichealth record on a display is done so via screen scraping or anotherappropriate method for determining the content currently being presentedon a computing system display.

Exemplary Architectural Components

Turning now to FIG. 3, an exemplary distributed architecture is shownand including therein high-level components: the Hive architecture 400,the IA architecture 500, and the Sensor architecture 600, according toone aspect of the present disclosure. In the present embodiment, thesethree architectural components are shown side-by-side with a firewallseparating each of these. According to various aspects of the presentdisclosure, the components may communicate through the firewalls viaHTTPS (SSL) over a suitable internet connection, or via any appropriatewired or wireless electronic communication network.

In one embodiment, the Hive architecture 400 includes components such asserver clusters and NoSQL data bases for providing cloud computingpower. The individual components of the Hive architecture 400 and theirfunctionality will be described in greater detail below in thediscussion of FIG. 4.

In various embodiments, the IA architecture 500 includes a plurality ofprocesses and APIs for communicating with Hive 206 as well as thePartner 204 computing system. The individual components of the IAarchitecture 500 will be described in greater detail below in thediscussion of FIG. 5.

In a particular embodiment, the Sensor architecture 600 includesprocesses and APIs for monitoring activity in EHRs as well as forexecuting predetermined instructions in response to trigger events(e.g., Rule Processes). The individual components of the Sensorarchitecture 600 will be described in greater detail below in thediscussion of FIG. 6.

Turning now to FIG. 4, an exemplary architecture 400 of the cloud-basedmicro-services system (e.g., Hive 206 in other figures) is shown, in oneembodiment. Included in the embodiment shown, are four applicationservices clusters providing Hive API Services 402, Business Services404, Domain Services 406, and Management Services 408. In oneembodiment, the Hive API Services 402 provides the exemplaryfunctionality to allow for external applications such as InsightsApplication 210, and Sensor 214 applications to authenticate, interactand exchange data with Hive 206 as these services utilize the differentBusiness Services 404 to perform an operation.

In one embodiment, the Business Services 404 provides the exemplaryfunctionality to allow for Hive 206 to orchestrate a number of DomainServices 406 to perform a common task and to aggregate information froma number of common services.

In various embodiments, the Domain Services 406 provides the exemplaryfunctionality for Hive 206 to apply business rules and other logic, andhandle persistence of business data such as organizations, patients,clinical events, patient contexts, users, computers, and other devices.

In a particular embodiment, the Management Services 408 provides theexemplary functionality to allow for monitoring, configuring, loadbalancing and managing the API Services 402, Business Services 404 andthe Domain Services 406. In various embodiments, and mentionedpreviously in the discussion of FIG. 4, the firewall 414 protects Hivearchitecture 400 from unsafe network traffic and may only allow secureHTTPS (SSL) communications from trusted sources (e.g., the Sensor andthe IA) through the firewall 414.

Continuing with FIG. 4 and also included in the present embodiment is aNoSQL database cluster including a NoSQL Graph Database 410 and a NoSQLKey-Value Database 412. In one embodiment, the NoSQL Graph Database 410is a database that uses nodes and edges to store and connect data withinthe database. Nodes can generally be thought of as telephone poles, andthe wires connecting each telephone pole can be thought of as edges. Invarious embodiments, a node is an individual part of a larger datastructure. According to aspects of the present disclosure, a Sponsor'spatient record may be stored at one node and a Partner's patient recordmay be stored at another node. In one embodiment, edges connect nodesand represent relationships between nodes. According to aspects of thepresent disclosure, nodes including information such as a Sponsorpatient record and a Partner patient record may include edges to a nodecorresponding to the Hive reconciled identifier for the two patientrecords. In a particular embodiment, implementing a graphicalnon-relational database (e.g., NoSQL Graph Database 410) allows forfaster queries as well as the ability to store hierarchical datastructures more efficiently. According to aspects of the presentdisclosure, the choice of NoSQL graphical non-relational databases maybe more efficient than standard relational databases because itincorporates the needed data types and complex relationships, allows forscaling, and is not limited by explicit and structured mechanismsregarding how the data should be managed. However, the present systemsare not limited to NoSQL graphical non-relational databases, and othertypes of databases such as key-value, document-based, column-based,etc., may be used.

In one embodiment, the NoSQL Key-Value Database 412 stores informationas database tables, which are collections of individual items. In aparticular embodiment, each item is a collection of data attributes andeach attribute is stored as a key-value pair. Continuing with thisembodiment, the items are analogous to rows in a spreadsheet, and theattributes are analogous to columns in a spreadsheet. Each item, in thisembodiment, is uniquely identified by a primary key, which includes itsfirst two attributes, called the hash and range. In various embodiments,a table stores data as collections of records, where each of the recordstores its data in a group of key-value attribute pairs. According toaspects of the present disclosure, a patient's care gap record may bestored as an item in a table with each attribute of a care gap recordsearchable by its name. In one embodiment, NoSQL Key-Value databases maybe more efficient than other databases because of the type of data isflat in structure and not hierarchical or relational in nature. In atleast one embodiment, the Hive architectural components such as theDomain Services 406 provides efficient indexing mechanisms for fasterqueries and direct data fetches based upon attribute keys.

Continuing with FIG. 4, protecting the Hive architecture 400 frominsecure networks is a firewall 414. In certain embodiments, thisfirewall 414 may be provided by a third party security service or may beproprietary software configured within the Hive architecture 400. Ingeneral, firewalls are designed to block unauthorized access into aparticular system while permitting outward communication. In the presentembodiment, the Hive API Services 402 shares a bi-directionalcommunication link between both the firewall 414 and the BusinessServices 404. The Business Services 404 further shares a bi-directionalcommunication link with the Domain Services 406. As shown in the presentembodiment, the Domain Services 406 further shares a bi-directional linkwith both the NoSQL Graph Database 410 and the NoSQL Key-Value Database412. According to various aspects of the present disclosure, anauthentication request from a Sensor or IA may only need to interactwith the services provided by the Hive API Services 402. According toother aspects of the present disclosure, persisting new informationinvolves storing the data in the Hive architecture 400. In thisscenario, the data may need to be transmitted from the Hive API Services402 through the Business Services 404 and Domain Services 406 to theNoSQL Graph Database 410 and NoSQL Key-Value Database 412.

Looking now at FIG. 5, an exemplary architecture 500 of an InsightsApplication (IA) is shown. In one embodiment, the exemplary architecture500 of the IA includes nine components, namely an Application Renderer502, a Security Management Process 504, a Print Capture Receiver Process506, a Content Surfacing Process 508, a Local Cache Process 510, a MainProcess 512, Local Systems Drivers and Processes 514, aLicensing/Software Update Process 516, and a Hive API ConnectivityProcess 518. In various embodiments, the Hive API Connectivity Process518 communicates with Hive to transmit and receive data through thefirewall 520 by means of SSL or HTTPS communications. In variousembodiments, the Licensing/Software Update Process 516 manages thecommercial software license granted by Holon (or another suitableentity) and orchestrates automatic software updates to the InsightsApplication communicating via the Hive API Services 402 (not shown).

In various embodiments, the Local Systems Drivers and Processes 514manage native computer operating system interactions to run InsightsApplication as a local service and translates the interactions from theMain Process 512 down to the local environment to render the applicationuser interactive screens and alerts in an operating system nativeformat. In various embodiments, the Main Process 512 serves as theprocess that is registered with the operating system of a localcomputing device, provides the runtime environment for the InsightsApplication, and is a manager of the other processes to perform specifictasks.

Continuing with FIG. 5, in various embodiments, the Local Cache Process510 allows the Insights Application to cache user information such asimages, user preferences, etc. used in various stages of the applicationworkflow to provide the users with alerts, application behavior andinteraction patterns. In a particular embodiment, the Content SurfacingProcess 508 allows the Insights Application to display informationreceived from Hive or other systems relevant to the current user sessionand context in the form of alerts, work-lists, etc.

In various embodiments, the Print Capture Receiver Process 506 allowsthe Insights Application to capture print streams and trigger differentworkflows when the application install is paired with a specific printeras further described herein (e.g., a local or remote physical printer orelectronic file destination). According to various aspects of thepresent disclosure, the Print Capture Receiver Process 506 allows forthe data being presented via the IA, data being monitored by the Sensor,clinical summaries from user interaction with electronic health records,data received from Hive, etc., to be packaged and generated as variousfile formats to be transmitted to third-party systems such as a Sponsororganization or another partnering healthcare clinic. According tovarious aspects of the present disclosure, the Print Capture ReceiverProcess 506 not only transmits particular data to a designated printeror electronic file location, but also may allow for various tasks to beautomated, such as transmitting prescription requests to a pharmacy inresponse to a medical professional administering care associated withthe need for a particular prescription medicine.

In one embodiment, the Security Management Process 504 allows theInsights Application to identify the application installation with Hive,authenticate users with Hive, manage user permissions and roles, manageuser sessions, and securely exchange data via the Hive API ConnectivityProcess 518. In certain embodiments, the Application Renderer 502 isresponsible for displaying the user interface elements of the InsightsApplication natively for the user's operating system, interpolates alertcontent served through the Content Surfacing Process, and manages userinteractions for data inputs and displays.

In one embodiment, FIG. 6 is an exemplary architecture 600 of a Sensor.In various embodiments, the Sensor is a software configuration of theHolon Connect Engine and is installed on a server. The Sensor includesmultiple elements such as an Administration Dashboard 602, SensorApplication(s) and Channels 604, a Main Process 606, a SystemsIntegration Service 608, Utility Services 610, Rules Processes 612, aLicensing/Software Update Process 616, a Hive API Connectivity Process614, and a firewall 618. In certain embodiments, the Systems IntegrationService 608 allows for the Sensor to transmit and receive data to andfrom the EHR 226. According to aspects of the present disclosure, theHive API Connectivity Process 614 allows for outbound SSL (HTTPS)communications to be transmitted to and through the firewall 618.

Exemplary Sequence Diagrams—System Processes

Turning now to FIGS. 7-11, and according to various aspects of thepresent disclosure, sequence diagrams illustrating exemplary processesof the disclosed system are shown. In one embodiment, FIG. 7 illustratesan exemplary data provisioning process. In various embodiments, theprocess starts when a data publisher (Sponsor 202), publishes a memberlist/member data (as shown in FIG. 2 as Member Data 218) to the CDAP 208(Step 1). In one embodiment, the CDAP 208 is an addressable location incomputer memory on a server within the publisher's computing system. Insome embodiments, the CDAP 208 is an addressable location in computermemory on a server within CollaborNet. One data publisher may be aninsurance company, and the data published may be a list of all membersenrolled in a health insurance plan. It should be understood from thediscussion herein that the member list/member data may includeinformation such as name, age, prescription history, surgical records,Medicare ID, or any other relevant information.

In various embodiments, the member list is updated and republished every30 days (or any suitable timeframe such as every day, every 7 days,every 60 days, etc.). In certain embodiments, at the beginning of the30-day period, a data publication engine (also referred to herein as theHolon Connect Engine 224) polls and pulls the data (member list) aspublished by the data publisher (Step 2). In one embodiment, polling andpulling the member list/member data includes requesting to download orcopy the member list/member data from the CDAP 208. In certainembodiments, the data publication engine may be granted access to thepublished member data based on certain Hive identifiers associated withthe data publication engine 224.

In one embodiment, after the data publication engine 224 accesses themember data from the CDAP 208, the member data is then parsed andevaluated (Step 3). In various embodiments, parsing and evaluating themember data includes filtering the member data, extracting relevantinformation, and determining the data that is relevant to the system.For example, the data publication engine 224 may parse the member dataand determine that the current information being evaluated is membernames and corresponding Sponsor 202 member identifiers.

In one embodiment, formatting the member data involves flattening, ornormalizing the data pulled from the CDAP 208 (Step 4). In certainembodiments, the member data is formatted in order to be stored in adatabase. In some embodiments, the data pulled from the CDAP 208 is notin an appropriate format to be processed in the exemplary system (e.g.,Hive 206). The parsing, evaluating, and formatting of data may involvefiltering out or flagging certain data points, performing calculations,or rearranging the data into a format that is more efficient andscalable.

Once the steps above are executed, the data publication engine 224 mayrequest to authenticate an electronic communication session with Hive206. In various embodiments, the authentication request from the datapublication engine 224 to Hive 206 may be initiated using certain APIs.In one embodiment, using the Hive API Connectivity Process 614 (as shownin FIG. 6) within the data publication engine 224, authentication withHive 206 may be requested over HTTPS communications (Step 5). In oneembodiment, Hive 206 receives the request for authentication using theservices within the Hive API Services 402 (as shown in FIG. 4). Itshould be understood from the discussion herein that the datapublication engine 224, as well as Hive 206, may be included inCollaborNet described above.

In one embodiment, a new electronic communication session between Hive206 and the data publication engine 224 is granted if the Hive APIServices server cluster 402 (discussed above) authenticates the requestsent by the data publication engine 224 (Step 6). Once an electroniccommunication session between the data publication engine 224 and Hive206 has been established, the data publication engine 224 may packageand secure the formatted data from the previous steps (Step 7). Invarious embodiments, packaging and securing the data involves encryptingthe data, or performing some other form of preparatory action before thenext step in the process, which involves posting the data to Hive 206.

In one embodiment, posting the data to Hive 206 involves transmittingthe packaged and secured data over a public network (Step 8). In variousembodiments, outbound HTTPS communications are used in order to transmitthe packaged and encrypted data. Once the data has been transmitted toHive 206, in particular embodiments, the data is unpackaged (which mayinclude, for example, decrypting the data). In certain embodiments, theunpackaged data and relationships between certain aspects of the dataare persisted in Hive 206 and stored (Step 9).

According to aspects of the present disclosure, after thirty days (orany other appropriate amount of time), another updated set of memberdata may be published by a data publisher to the CDAP 208 (Step 10). Itshould be understood from the discussion herein, that once updatedmember data is published to the CDAP 208, the data publication engine224 may poll and pull the data, and the process described above mayrepeat (Step 11).

Looking not at FIG. 8, the present embodiment illustrates theorganization and user provisioning process, according to one embodiment.In various embodiments, organizations and users of the present systemmay include healthcare organizations, such as hospitals or healthclinics, private medical practices, and medical professionals that workat these establishments. Typically, these users of the system accesselectronic health records in order to complete daily work tasks. Thepresent embodiment outlines the process involved with establishing theseorganizations and certain users in the CollaborNet system.

In one embodiment, the IA 210, once launched (Step 1), allows for thecreation of a new organization as a Sponsor 202. In various embodiments,and prior to creating a new organization as a Sponsor 202, the IA 210may call the Hive API Service 402 to authenticate the IA 210 user (Step2), and Hive 206 may grant authenticate and grant the access session(Step 3). In this embodiment, a user may authenticate as asuper-administrative user. In various embodiments, creating a Sponsor202 organization within the IA 210 allows for Hive 206 to associatecertain member list and member data with a certain Sponsor 202. Incertain embodiments, once a Sponsor 202 is created within the IA 210(Step 4), the information regarding the new Sponsor 202 may betransmitted to, and stored in, Hive 206. In one embodiment, transmittingthe information regarding the new Sponsor 202 to Hive 206 allows forHive 206 to maintain a record of the activity associated with the newSponsor 202.

According to aspects of the present disclosure, once the IA 210 savesthe new Sponsor 202 information to Hive 206 (Step 5), Hive 206 persiststhe new Sponsor 202 details within Hive 206 and also associates it witha newly-generated Sponsor Hive ID in order to uniquely identify thatSponsor 202 from all other present and future Sponsors 202 (Step 6). Invarious embodiments, once a Sponsor 202 is created, a substantiallysimilar process as described above may be followed to create a new userwithin the Sponsor 202. In one embodiment, a new user associated withthe Sponsor 202 may be created within the IA 210 and associated with anewly-generated user Hive ID in order to uniquely identify that userfrom all other present and future users (Step 7). According to aspectsof the present disclosure, once the new user is created within theSponsor 202, the information associated with the new user may be savedand persisted with Hive 206 (Steps 8 and 9). In certain embodiments,persisting a new user with the user's Hive ID may include allowing thenew user to be tracked, identified, and managed within Hive 206.

In one embodiment, a user defined within that Sponsor 260 may create oneor more Partners 204 within that Sponsor 202. In one embodiment, aPartner 204 created within a Sponsor 202 is assigned a newly-generatedPartner Hive ID in order to uniquely identify that Partner 204 from allother present and future Partners 204, regardless of Sponsor 202 (Step10). According to aspects of the present disclosure, once the newPartner 204 is created within the Sponsor 202, the informationassociated with the new Partner 204 may be saved and persisted with Hive206 (Steps 11 and 12).

In various embodiments, there may be a first administrative user for aPartner 204 created by a Sponsor 202 user. That first administrativeuser may then create additional users, both other administrative andgeneral users, as necessary for that particular Partner. Insubstantially similar processes to creating Sponsor 202 users, Partner204 users are created in IA 210, and persisted in Hive 206, with eachuser assigned a newly-generated Hive user ID.

According to aspects of the present disclosure, if the Partneradministrative user is authenticated by Hive 206, then a new accesssession may be granted between Hive 206 and the IA 210. Once anadministrative user is authenticated, a new user may be created for thePartner 204 to which the presently authenticated administrative userbelongs. In this embodiment, all users created are automatically definedin Hive 206 as users belonging to the Partner 204 under which they werecreated.

Once a new Partner 204 user is persisted with user's Hive ID, theprocess may continue to associate the EHR's 226 proprietary user ID tothe Partner 204 user's Hive ID. In one embodiment, associating the EHR's226 proprietary user ID to the user's Hive ID through the IA 210 mayallow for the CollaborNet system to match the IDs across the variouscontributing elements of the system.

Turning now to FIG. 9, a sequence diagram illustrating the membershipattestation and cross-system identity matching process is illustrated,according to a particular embodiment. In one embodiment, this processincludes the communication between Hive 206, the Sensor 214, and an EHR226. In the present embodiment, the process begins at the Sensor 214 byconfiguring the Sensor 214 with a Hive Partner ID so that a relationshipbetween an instance of the Sensor 214 and a specific Partner 204 may beidentified (Step 1).

In one embodiment, once the Sensor 214 is configured, the Sensor 214 mayuse appropriate API function calls to authenticate an electroniccommunication session with Hive 206. In various embodiments, the Sensor214 may use the Hive API Connectivity Process 614 to send outbound HTTPScommunications to Hive 206 (Step 2). In one embodiment, Hive's APIServices server cluster 402 will receive the API authentication requestfrom the Sensor 214 and grant an electronic communication session (Step3). If the electronic communication session is granted by Hive 206, thesession may continue to allow the Sensor 214 and Hive 206 to receive andtransmit data as necessary. According to aspects of the presentdisclosure, the session between Hive 206 and the Sensor 214 may allowfor the Sensor 214 to pull Sponsor member data 218 (shown in FIG. 2)from Hive 206 for that particular Sponsor 202 within which the Partner204 was created (Step 4).

In one embodiment, once the session between Hive 206 and Sensor 214 isestablished, the Sensor 214 may request to open an electroniccommunication session to the EHR 226 (Step 5). In certain embodiments,the EHR 226 may grant access to the Sensor 214 if the sensor isauthenticated (Step 6). In various embodiments, granting access from theEHR 226 to the Sensor 214 may allow for the Sensor 214 to receive andanalyze data from the EHR 226. In various embodiments, patientinformation included in the EHR 226 may be queried by the Sensor 214 andbe evaluated using certain processes as configured within the Sensor214. In various embodiments, the patients included in the EHR 226 may becorrelated to a Sponsor's 202 member Hive ID by means of a matchingprocess using the Sponsor's 202 member data 218 and the EHR's 226patient data (Step 7).

Continuing with the present embodiment, the Sensor 214 may then updatethe Sponsor 202's members stored within Hive 206 with the newinformation regarding the patients accessed in the EHR 226 (Step 8). Incertain embodiments, upon receiving this information, Hive 206 maypersist the Sponsor's 202 members with the new information retrievedfrom the EHR 226 (Step 9).

Turning now to FIG. 10, in one embodiment, a sequence diagramillustrating the EHR context control process is shown. In oneembodiment, the EHR control process begins when the Sensor 214 opens anelectronic communication session to monitor EHR 226 events (Step 1). Invarious embodiments, and as will be discussed below, EHR 226 events mayinclude a medical professional opening a patient's electronic healthrecord. In this scenario, opening an electronic communication session tothe EHR 226 may allow the Sensor 214 to recognize this event and respondaccordingly.

In one embodiment, the EHR 226 may grant access to the Sensor 214, whichmay then make certain API calls in order to authenticate access withHive 206 (Steps 2 and 3). According to various aspects of the presentdisclosure, the API authentication between the Sensor 214 and Hive 206is coordinated by the Hive API Connectivity Process 614 within theSensor 214 and the Hive API Services server cluster 402 within Hive 206.In certain embodiments, the API authentication calls are communicatedbetween Hive 206 and the context server (e.g., Hive 206) as HTTPScommunications. Further, and in various embodiments, once the access toa new session is granted between Hive 206 and the Sensor 214 (Step 4),the Sensor 214 may wait until an appropriate triggering event occurs inthe EHR 226 to communicate any data to Hive 206.

In one embodiment, the Sensor 214 is configured to establish anelectronic communication session the EHR 226 in order to query forpatient context or other information every three seconds (or anyappropriate amount of time). In one embodiment, at Step 5, anapplication login event may occur where a user at the Partner 204 mayenter his/her credentials (e.g., user name and password, token, etc.)for accessing the electronic health records at EHR 226. In response tothe user at the Partner 204 entering his/her identity credentials, thecredentials, or an identifier corresponding to the credentials, may betransmitted to Hive 206 by the Sensor 214 for generating a sessionbetween the Hive 206 and Sensor 214 for transmitting informationrelating to trigger events (Steps 6 and 7). In various embodiments, inresponse to the Sensor 214 transmitting the Partner 204 credentials toHive 206, the Sensor 214 monitors the EHR system 226 at variousintervals for a trigger event (Step 8). According to various aspects ofthe present disclosure, the Sensor 214 may monitor for trigger events bydirectly accessing the EHR system 226 and detecting manipulation oraccess to a particular electronic health record, screen scrapingelectronic records from a computing system display at the Partner 204,or by intercepting API calls to the EHR system 226 for particularelectronic health records associated with particular patients.

In response to a user at the Partner 204 accessing a particularelectronic health record (Step 9), the Sensor 214 recognizes this actionas a trigger event (Step 10), and the Sensor 214 further transmitshealthcare information, a patient identifier, and an identifier relatingto the user accessing the electronic health record, to Hive 206 to bepersisted (Steps 11 and 12). According to aspects of the presentdisclosure, the Sensor 214 may continue to query the EHR 226 for patientcontext or other information after a trigger event is detected. In someembodiments, persisting this information to Hive 206 may allow for thetransmitted healthcare information to be easily associated and connectedwith other relevant events, triggers, and context.

Turning now to FIG. 11, a sequence diagram illustrating the exemplarycontext sensitive alert and detail data presentation process is shown,according to one embodiment. In the present embodiment, the exemplaryprocess begins when the IA 210 is launched (Step 1). In variousembodiments, the IA 210 is launched by clicking an icon on the screen ofthe computing system, running a script in a command line, or othervarious methods of launching a software application. According tovarious aspects of the present disclosure, when the IA 210 is launched,the IA 210 may make various API calls to authenticate the user launchingthe IA 210 (Step 2). In one embodiment, the IA 210 uses the Hive APIConnectivity Process 518 to send HTTPS communications to Hive 206. Hive206 may then receive those HTTPS communications at the Hive API Servicesserver cluster 402.

In various embodiments, the IA 210 user launching the application may beauthenticated by Hive 206 (e.g., by user name and password, a token, orsimilar credentials), which may in return result in the IA 210 pollingthe context service regarding the authenticated IA 210 user periodicallyfor a predetermined amount of time (Steps 3 and 4). In one embodiment,the IA 210 may poll the context service regarding the authenticated IA210 user every 3 seconds in order to have access to consistently updateddata. However, it should be noted that the IA 210 may poll the contextservice at different rates. In various embodiments, the IA polls Hive206 periodically in response to a trigger event, such as the triggerevent described above in the discussion of FIG. 10. In response to aSensor 214 detecting an accessed electronic health record andtransmitting healthcare information and identifiers relating to theparticular patient and the user at the Partner 204, the IA 210 isconfigured to receive matching or corresponding healthcare informationfrom the Hive 206 (Step 5).

In one embodiment, Hive 206 may transmit the current patient context andapplicable Sponsor 202 published member data 218 to the IA 210, and theIA 210 may be configured to present the information to the IA 210 useras a summary of the Sponsor's 202 published member data 218. It shouldbe understood from the discussion herein that this information may bepresented to the user of the IA 210 in the form of an alert. In aparticular embodiment, the information received at the IA 210 from Hive206 may be healthcare gap information (e.g., information other than whatis stored locally) and the healthcare gap information may be presentedto the user at IA 210 as pop-up notification or bubble (Step 6).

According to various aspects of the present disclosure, the user of theIA 210 may select the alert (Step 7) displayed on a computing device.According to various aspects of the present disclosure, and in responseto selecting the bubble, additional information relating to thenotification, but not included in the initial bubble, may “slide-out”from behind the boundaries of the display. In one embodiment, theprocess of selecting the alert may include clicking on the alert with acomputer mouse, touching the alert on a touch screen, or anotherappropriate way to select available information within a computingsystem.

In one embodiment, selecting the alert presented to the user of the IA210 may result in the IA 210 presenting a fixed sized insights datadetail panel, opening sized to approximately 25% of the screen width,and 100% of the screen height. In one embodiment, the detail panel maybe presented from the right side of a screen and the detail panel mayinclude the Sponsor 202 published member insights detail data assummarized in the previous alert (e.g., healthcare gap data). In otherembodiments, the IA 210 may open by means of launching a new full sizedwindow or a new application (Step 8).

Exemplary Code Gap Detection

Turning now to FIG. 12, an exemplary flowchart illustrating theexemplary code gap detection process 1200 is shown, according to oneembodiment of the present disclosure. In various embodiments, theprocess begins at step 1202, where the cloud-based micro-services system206 receives health record data from the Sensor 214 in response to atrigger event.

According to various aspects of the present disclosure, the triggerevent may be a doctor at a Partner 204 organization opening anelectronic health record of a particular patient. In a particularembodiment, the Sensor 214 is configured to monitor activity, such asreading and writing to the EHR 226, at the Partner 204 organizationcomputer system. In certain embodiments, the Sensor 214 may interceptapplication programming interface calls to the EHR 226 for retrieving anelectronic health record associated with a particular patient. In someembodiments, the Sensor 214 may detect an electronic health recordassociated with a particular patient being presented on the display ofthe Partner 204 organization computing system via screen scraping or asimilar method. According to certain embodiments, if the Sensor 214detects that a particular patient's electronic health record iscurrently opened, surfaced on the screen of the doctors computingsystem, or any other suitable method of accessing the record, the sensormay transmit at least a portion of the electronic health record, as wellas an identifier associated with the patient in focus, to thecloud-based micro-services system 206.

At step 1204, and in response to receiving the at least portion of theelectronic health record and the corresponding patient identifier, thecloud-based micro-services system 206 retrieves one or more matchinghealth records from internal databases. In one embodiment, the one ormore matching health records are health records associated with theparticular patient, but not necessarily associated with the Provider 204that accessed a patient health record at step 1202. In variousembodiments, the one or more matching health records may have originatedfrom a separate Partner that the patient has previously visited, or theone or more matching health records may have been provided by a Sponsor.

At step 1206, the system compares the received health record data andthe one or more matching health records to determine gaps in coding.According to various aspects of the present disclosure, the code gapsare identified by cross referencing the data from the received healthrecord data and the one or more matching health records. In oneembodiment, inconsistencies between the two sets of data will generallybe determined as a gap. As will be shown and described below whenreferencing FIG. 13, gaps in coding are exposed when two sets of patientdata that should be consistent include contradicting, missing, orgenerally inconsistent data.

At step 1208, and according to one embodiment, the system stores thedetermined healthcare code gap data in a context table, shown anddescribed in greater detail below in the discussion of FIG. 13.According to various aspects of the present disclosure, the contexttable is a database accessible to the IA, and storing the healthcarecode gap information in this particular location allows for a Partner204 to access gap information at the point and time of care via the IA.

At step 1210, the system determines if the stored records in contexttable expose gap information relating the particular patient'selectronic health record in focus. If no gaps were detected, the processmay terminate. In one embodiment, if the context table does include gapinformation relating to the particular patient's electronic healthrecord, the cloud-based micro services system 206 may transmit the gapinformation to the IA to be presented on the display of the computingsystem at the Partner 204 in the form of an alert (step 1212). Invarious embodiments, the alert is a pop-up or slide-out feature thatgenerally remains “out-of-sight” or mostly hidden until an alert issurfaced. In particular embodiments, examples of the exemplary alertappearance generated by the IA are shown in FIG. 24 below, according toone embodiment.

Exemplary Context Table Data Structure

Looking now at FIG. 13, an exemplary electronic health record datastructure and context table (also referred to herein as context service)are shown, according to one embodiment. In various embodiments, anelectronic health record at a Partner 204 organization may includeinformation such as, but not limited to, date of care, the coding formatused at the Partner 204 organization, particular codes corresponding toadministered care, patient name, patient date of birth, insuranceinformation, etc. In the present embodiment, exemplary electronic healthrecords (or at least portions of electronic health records)corresponding to a particular patient are shown including a date, codingformat, and particular code corresponding to administered care. Thechart 1302, corresponding to a “Partner 1 EHR” includes two instances ofcare provided to the particular patient, these instances includingtreatment for high blood pressure (Code: 796.2) on Oct. 6, 2017, andwell as treatment for diabetes (Code: 250.00) on Oct. 27, 2017. Invarious embodiments, Hive 206 may compare the chart 1302 to a chart 1304corresponding to a “Partner 2 EHR.” According to various aspects of thepresent disclosure, both the Partner 1 EHR and the Partner 2 EHR mayhave treated the particular patient at some point in time, and bothinclude separate records corresponding to the past treatment. The chart1304 includes only one instance of care provided to the particularpatient, this care being treatment for diabetes (Code: 250.40) on Oct.27, 2017. In a particular embodiment, Hive 206 may compare each entry inthe respective health records to identify inconsistencies or “gaps” inthe data. According to various aspects of the present disclosure, thedetected gaps are stored in a context table 1306 within Hive 206. Insome embodiments, when queried IAs for health record data correspondingto particular patients, Hive 206 may transmit the gap data from thecontext table 1306 to the requesting system, where the gap data mayfurther be presented onto a display in the form of a contextual alert,as shown and described below in FIG. 24.

Exemplary Paired System(s) Identity Management

Turning now to FIG. 14, an exemplary external paired system(s) identitymanagement overview and environment is shown, according to oneembodiment. In the present embodiment, two organizations labeled Sponsor202 and Partner 204 are shown. In various embodiments, each organizationincludes a system, such as a computing system, and in the case of thePartner 204, a user of the system. According to various aspects of thepresent disclosure and for the sake of example, the Partner 204 user,John Doe, signs into both the Insights Application 210 and the EHR 226.In certain embodiments, the sign-in process may occur automatically oncomputer system startup or may include signing into the IA 210 using thefeatures of the IA 210 as shown in FIGS. 22 and 23. In particularembodiments, the EHR 226 is operatively connected to the Sensor 214. Itshould be understood from the discussion herein that, in particularembodiments, the Sensor 214 and the IA 210 are configured to operateasynchronously but in conjunction with each other as communications withHive 206 occur. In one embodiment, the Sensor 214 monitors for activityregarding particular patient charts accessed from the EHR 226 by theuser John Doe, and if a certain patient chart is opened (e.g. chart ID:pid123), the Sensor 214 may submit at least a portion of thisinformation to Hive 206. Further, and on an interval basis, the IA 210may execute the Hive API Connectivity Process 518 (as shown in FIG. 5)to query Hive 206 for information regarding the particular user signedinto the IA 210 and any corresponding patient context currently open inthe EHR 226 by the user (as referenced by a paired system identifier tobe discussed later herein). In various embodiments, the informationregarding the patient in context is then transmitted from Hive 206 tothe IA 210. In general, while asynchronous connections are being made toHive 206, the IA 210 and the Sensor 214 operate simultaneously and theactivity monitored by the Sensor 214 may determine the informationtransmitted to the IA 210 by Hive 206.

Continuing with FIG. 14, in various embodiments, the relationships ofdisparate identities (of patients, users, providers, etc.) within thedata held in Hive 206 and the Sponsor 202 and Partner 204 organizationsare achieved via mapping of various identifiers. Examples of theidentifiers and associated mapping concepts corresponding to the presentembodiment are listed below.

Partner—Person Identifiers (doctor “John Doe” and patient “Jane Smith”)

Doctor John Doe's national provider identifier is “NPI: abcdef”

-   -   In various embodiments, the NPI associated with doctor John Doe        is his National Provider Identifier. This identification number        may be associated with John Doe anywhere within the U.S. as long        as he is a practicing medical professional regardless of his        place of work. Typically, the NPI is not created by the EHR 226,        but is typically stored within the configuration of the EHR 226.

Doctor John Doe's Paired System Identifier at Partner is “Paired ID:6789”

-   -   In various embodiments, a paired system ID is the concept of        linking a user account within the IA 210 to a user ID assigned        and managed by the third party system (e.g. the EHR system 226        where the Sensor 214 is monitoring for activity) and is        fundamentally a bridging mechanism to relate a single user        defined in multiple disparate systems to actions for trigger        events. In this example, the paired system ID is an        identification number that associates doctor John Doe as a user        of the third party system (e.g. EHR 226) of the Partner 204 with        the currently signed-in user of the IA 210 known as        “jdoe@org4.net”. In particular embodiments, associating data        with one identification number rather than two individual        identification numbers may enable the system to efficiently        conduct various look-ups and/or other tasks. For example, if a        user signs into the EHR 226 of the Partner 204 and the database        of the EHR 226 stores “system user: 6789 has signed in and has        opened chart: pid123”, then the Sensor 214 may relay the        currently signed in user to Hive 206 where a match between user:        6789 will be made to IA 210 user jdoe@org4.net.

Patient Jane Smith's Chart identifier at Partner is “chart ID: pid123”

-   -   This identification number may be a system assigned patient's        chart ID, and represents Jane Smith within the EHR system 226 of        the Partner 204. In various embodiments, Jane Smith's electronic        health record is assigned this chart identification number upon        chart creation within the EHR 226 at the Partner 204.

Hive—Person Identifiers (Doctor “John Doe” and Patient “Jane Smith”)

Doctor John Doe's Hive Identifier is “Hive ID: 4589214”

-   -   In various embodiments, this Hive ID is a Hive-generated        identification number associated with doctor John Doe. In        particular embodiments, the system associates any additional        linked identifiers or activity involving John Doe between        Sponsors and any associated Partners across CollaborNet.

Patient Jane Smith's Hive Identifier is “Hive ID: 56781243”

In various embodiments, the Hive ID for Jane Smith is a Hive-generatedidentification number associated with Jane Smith universally within Hive206. In various embodiments, Hive 206 may use this identifier toassociate any additional linked identifiers or activity involving JaneSmith between the Sponsor 202 and any associated Partners (e.g., Partner204).

-   -   In one embodiment, the Sponsor 202 submits member data 218 to        Hive 206 on an interval basis. Continuing with this embodiment,        included within the member data 218 may be information relating        to a person named Jane Smith. In various embodiments, the        Sponsor 202 may assign a member identification number to this        person, such as a Medicare ID (e.g. 79a3bc5), along with a        person identifier of Jane's primary care provider, John Doe. In        the present embodiment, a National Provider Identifier, known as        an NPI, identifies the primary care provider John Doe as “NPI:        abcdef”.

In one embodiment, Jane Smith visits the Partner location 204 (e.g., afamily health clinic) in need of medical attention. Her doctor, JohnDoe, is associated with the Partner location 204 and may have an EHRuser identification number of “6789” that identifies him within thePartner 204 EHR system 226. In various embodiments, John Doe will alsosign in to the CollaborNet network and system through the InsightsApplication 210 using his user name “jdoe@partner.org”. In particularembodiments, once John Doe signs in to the EHR 226 with his user ID6789, his profile, previously configured with an external paired systemID as described above, will associate the Hive 206 user“jdoe@partner.org” to the EHR user 6789 and establish a session betweenthe IA 210 and Hive 206 that may allow John Doe to receive additionalinformation regarding Jane Smith that is not included in her electronicmedical record, as described herein.

According to aspects of the present disclosure, the Sensor 214 deployedto the Partner 204 is configured to monitor user activity within the EHR226. For example, if John Doe, user: 6789, opens the patient chartassociated with Jane Smith, chart: pid123, the action of opening thechart may trigger the Sensor 214 to send the context of “chart: pid123opened by user: 6789” (attributing patient Jane Smith's chart opening touser John Doe) to Hive 206.

In one embodiment, the IA 210 queries Hive 206 every few seconds (or anysuitable amount of time) for patient context associated to the currentlyauthenticated user jdoe@partner.org, corresponding to external pairedsystem id 6789. In particular embodiments, given Hive 206 has alreadystored a patient context (e.g. chart: pid123) for IA 210 userjdoe@partner.org (external paired system id of 6789) to the database,upon receiving the query from the IA 210, the clinical contentoriginally sourced from the Sponsor 202 to Hive 206 (e.g. clinical gapsin care, etc.) is sent to the IA 210 and further surfaced within theworkflow of the third party EHR system 226 of John Doe.

External Paired System(s) Identity Management—Flowchart

FIG. 15 is a flowchart illustrating the exemplary external pairedsystem(s) identity management process 1500, according to various aspectsof the present disclosure. In various embodiments, this exemplaryprocess corresponds to the external paired system(s) identity managementoverview, shown in FIG. 14 and described immediately above, andreferences the components as shown in FIG. 2.

In one embodiment, the process 1500 begins at step 1502, which includesmembership data 218 from the Sponsor 202 being retrieved from a CommonData Access Point 208 by the Holon Connect Engine 224 (a component ofHive 206). As discussed throughout the present disclosure, membershipdata 218 may include information corresponding to individuals enrolledin certain Sponsor 202 organizations (e.g., insurance providers). Invarious embodiments, the membership data 218 may include a list ofMedicare beneficiaries (e.g., “member list”). In some embodiments, amember list 218 may include relevant information such as name, gender,date of birth, age, Medicare beneficiary identification, primary careprovider information, gaps in clinical care, gaps in claims submissionand coding, MSSP/MSO/ACO identifiers, etc. relating to the particularpatients included in the member list.

Proceeding to step 1504, Hive 206 associates all members included in themembership data 218 with Hive 206 identification numbers. For example,and described above in the discussion of FIG. 14, a patient Jane Smithis assigned a Hive 206 identification number of “56781243” that willallow for her health related activity to be tracked across Hive 206 aswell as various third-party systems that communicate with Hive 206.

At step 1506, the Sensor 214 at the Partner 204 submits patient contexts216, including at least a portion of an electronic health record, apatient identifier, and a Partner identifier, to Hive 206, according toone embodiment. Furthermore, at step 1508, Hive 206 reconciles andassociates external system identifiers from the Partner 204 withinternal Hive IDs, according to various embodiments. Proceeding to step1510, in various embodiments, users are provisioned in the IA 210 andare paired with third-party system identifiers from within the IA 210user profile. According to various aspects of the present disclosure,submitting patient contexts 216 (e.g., chart data) to Hive 206, andfurther associating IA 210 users with third-party system identifiersallows for Hive 206 to monitor electronic health record activityassociated with the submitted patient contexts 216, and to further allowthe IA 210 users to be alerted about the activity. According to variousaspects of the present disclosure, the Hive 206 may receive patient datafrom the Sensor 214 in various scenarios. For example, the Sensor 214,in response to direct connection to an EHR 226 and detecting electronicaccess to a particular electronic health record, may transmit patientdata to Hive 206. In another example, the Sensor 214 may periodicallytransmit patient data to the Hive 206 via monitoring EHR 226 activitiesnot related to accessing a particular electronic health record.

At step 1512, and according to one embodiment, the user at the Partner204 organization may open an electronic health record (e.g. patientchart). In various embodiments, opening an electronic health record mayinclude displaying the electronic health record on the screen of acomputing device, adding or amending data included in the record, etc.Proceeding to step 1514, and in response to accessing an electronichealth record, the Sensor 214 senses particular patient context (e.g.,data corresponding to a patient included in the member list 218) andsends a chart open event to Hive 206 with external system user IDs (e.g.external paired system IDs), according to one embodiment. According tovarious aspects of the present disclosure, the Sensor 214 is configuredto monitor activity corresponding to particular patients at an EHRsystem 226. In particular embodiments, the Sensor 214 may be configuredto monitor for trigger events such as opening electronic health records,augmenting electronic health records, submitting or reporting portions(if not all) of electronic health records, etc.

Proceeding to step 1516, in one embodiment, Hive 206 associates thechart ID and the external paired system ID with the IA 210 user at thePartner 204 location and the member from the Sponsor 202. In particularembodiments, at step 1516, Hive 206 may match the previously receivedpatient context data 216 with the various identification numbersassociated with the Sensor 214 at the Partner 204, operated by the userof the IA 210, in response to receiving the chart open event (e.g.trigger event) at step 1514.

In various embodiments, at step 1518, the IA 210 queries Hive 206 forcurrently authenticated user events and contexts. In particularembodiments, at step 1518, Hive 206 may include clinical data from otherthird-party systems relating to the electronic health record of theparticular patient being accessed at the Partner 204 location. Accordingto various aspects of the present disclosure, querying Hive 206 forcurrently authenticated user events and contexts may include executingvarious API calls for retrieving the related clinical data. Proceedingto step 1520, Hive 206 submits or transmits patient context andadditional content to IA 210 for the user at the Partner 204organization. In various embodiments, at step 1522, the IA 210 surfacesthe Sponsor 202 gap content 228 into the workflow of the third-partysystem at signed-in user workstation.

Follow a Patient

Turning now to FIG. 16, a diagram illustrating the process referred toherein as “follow a patient” is shown, according to one embodiment. Invarious embodiments, the “follow a patient” concept can be understood asthe ability for multiple payer organizations and healthcare clinicorganizations, depicted as “clinic” in the drawing, to share and monitorinformation regarding individual patients throughout a web ofinterconnectivity by implementing a distributed architecture and acloud-based micro-services system 206 (e.g., Hive).

Shown in the present embodiment are two payer organizations indicated asPayer 1602A and Payer 1602B, four Clinic organizations indicated asClinic 1604A, Clinic 1604B, Clinic 1604C, and Clinic 1604D, and threepatients indicated as patient 1606A, patient 1606B, and patient 1606C.In the present embodiment, patient 1606A and patient 1606B are bothincluded in Payer 1602A's organization (e.g. purchase insurance from thesame payer/insurance provider). According to aspects of the presentdisclosure, patient 1606A and patient 1606B may be included in anymember lists/member data made available by Payer 1602A. In certainembodiments, a patient, such as patient 1606A, may visit severaldifferent clinic organizations (e.g., physicians or health careestablishments).

As shown in the present embodiment, patient 1606A is associated with twoclinic organizations, Clinic 1604A and Clinic 1604C. Based on theassociation of patient 1606A with one payer organization and two clinicorganizations, the cloud-based micro-services system 206 (e.g., Hive)may create a web of connections between each organization associatedwith patient 1606A. In one embodiment, if patient 1606A were to receivea routine checkup at one of the clinic organizations, the other clinicorganization as well as the payer organization may receive statusupdates pertaining to encounter events or updates to gap closureactivity provided to the network by the clinic organization via thecloud-based micro-services system 206 (based on the matching ofidentifiers and normalization of data as discussed herein and describedin further detail immediately below).

Turning now to FIG. 17, a flowchart describing the exemplary “follow apatient” process 1700 is shown, according to one embodiment. Asdiscussed above, the follow a patient process 1700 includes matchingexternal identifiers, as well as general patient demographics, in orderto track and correlate particular patient activities across variousPartner organizations. In one embodiment, the process begins at step1702 where the cloud-based micro-services system receives a request forhealth record data from a first third-party, the request including aparticular patient identifier and a third-party identifier relatingcorresponding to the first-third party.

At step 1704, and in one embodiment, the cloud-based micro-servicessystem matches the particular patient identifier with correspondingelectronic health record data and indicates the matched data asassociated with the first-third party identifier. In one embodiment,matching the particular patient identifier with corresponding healthrecord data allows for the cloud-based micro-services system to create a“network” or “web” of third-party systems that are associated with aparticular patient. In various embodiments, the cloud-basedmicro-services system matches the particular patient identifier with thecorresponding electronic health record data similarly to the processdescribed in the discussion of FIG. 16.

At step 1706, and as a result of matching the particular patientidentifier with corresponding electronic health record data, thecloud-based micro-services system stores the particular patientidentifier as associated with the corresponding health record data andthe first-third party identifier. According to various aspects of thepresent disclosure, associating the particular patient identifier withthe corresponding health record data and first-third party identifiermay allow for the system to identify that additional health record datarelating to the particular patient from other third-party systems may beof interest to the first-third party system.

Proceeding now to step 1708, the cloud-based micro-services systemreceives health record data associated with the particular patientidentifier from a second third-party. According to various aspects ofthe present disclosure, the health record data from the second-thirdparty may include data other than the data received from the first-thirdparty. In a particular embodiment, the health record data received fromthe second-third party may be in response to a trigger event (e.g.,accessing an electronica health record) at the second third-party.

At step 1710, the cloud-based micro-services system transmits the healthrecord data received from the second third-party to the first-thirdparty due to matching particular patient identifiers associated with thedata. In one embodiment, the system may transmit at least a portion ofthe newly received healthcare data to the first third-party. Accordingto various aspects of the present disclosure, the transmitted data maybe presented to the first third-party as an alert informing the providerof the first third-party that there has been activity relating to theparticular patient's health record data from another provider (thesecond third-party). This functionality allows for providers to havebetter information regarding their patients, allowing them to providebetter care as well as various other advantages discussed herein.

Exemplary Task Automation

Turning now to FIG. 18, a flowchart illustrates the exemplary taskautomation process 1800, according to one embodiment. In variousembodiments, the system may automate tasks such as prefilling HealthRisk Assessment (HRA) forms from a payer (or any third-party formrequiring chart data elements), lab order service eligibility checking,population health portal access and data searches, etc. According tovarious aspects of the present disclosure and as shown in FIG. 6, theSensor 600 includes a rules processes engine 612 (e.g., Rules Processes)for determining the appropriate actions for automating particular tasksbased on the detected trigger event. In a particular embodiment, therules processes engine 612 is a software module included within theSensor 600, and pre-configured instructions from the rules enginedetermine how the Sensor 600 responds to various trigger events. Oneexample of using the rules processes engine 612 and Sensor 600 toautomate tasks is to configure the system to automatically presentalerts to users that may not have compatible insurance for a particularservice, such as ordering a medication. In this example, the Sensor 600is configured to monitor for new order workflows. When a new orderworkflow is detected, the Sensor 600 checks the patient's insurance andcorrelates the order and insurance with a list of items that areexcluded from being covered under certain types of insurance. If a matchis found, the system may automatically present an alert to the userordering the medication explaining the orderable service will not becovered by the insurance and that an advanced beneficiary notice mayneed to be signed ahead of completing the order. In pre-existingsystems, this process of determining appropriate insurance coverage,alerting the patient, and further notifying them of next steps may takedays to effectively complete, which may be too long if the patient is ona constrained timeline for receiving the medication. The task automationprocess described herein presents a technical solution that effectivelyhandles issues such as the problem described above in near real-time.

In one embodiment, the instructions for task automation processes 1800are initially created and stored at Hive, and later pushed down toremote Sensor(s) upon command. In various embodiments, after pushingtask automation instructions to the remote Sensor, the Sensor retainsthe instructions for that particular trigger event until an updatedcommand is sent down from Hive to the Sensor for changing theconfiguration or instructions. In some embodiments, the system mayinclude a catalog of Sensor configurations and instructions in Hive as aback-up log of all available task-automation configurations. Accordingto various aspects of the present disclosure, maintaining this catalogacts as a failsafe and recovery measure if certain task-automationconfigurations are lost, and also maintaining the catalog remotely savesmemory at local systems.

In particular embodiments, the task automation instructions may beconfigured in a multitude of ways. In one embodiment, task automationinstructions are configured as IFTTT (if this than that) instructions,whereby the instruction is created in a user interface similar to theintegration engine (e.g., System Integration Service 608) and creatingthe instruction includes describing the task requirements and storingthe task requirements on the local Sensor. In other embodiments, theinstructions may be updates to a browser based web extension that ismonitoring web activity for API calls returning to a web front end froma remote backend hosted by a third-party vendor. In particularembodiments, task automation instructions may be configured andinstalled on a user's computing system as a service, rather that theuser configuring the implementation. According to various aspects of thepresent disclosure, certain task automation instructions may bepreviously installed on all instances of the herein described system.

Referring now to the exemplary flowchart in FIG. 18, according to oneembodiment, the exemplary task automation process begins at step 1802,when the Hive receives health record data in response to a trigger eventat the Sensor. As discussed immediately above, in various embodiments,Hive may store various sets of predetermined instructions and Sensorconfigurations for responding to trigger events detected by the Sensor.At this step, the Sensor transmits the health record information and/orpatient identification information to be matched with correspondingpredetermined instructions.

At step 1804, and according to various aspects of the presentdisclosure, Hive matches health record and identifier with thepredetermined instructions, and at step 1806, Hive transmits thepredetermined instructions to the Sensor for initiating thepredetermined action. In some embodiments, the predeterminedinstructions are stored locally at the Sensor.

Exemplary Printer Driver

Turning now to FIG. 19, an overview of a “print capture” process isillustrated, according to one aspect of the present disclosure. Theprint capture process, or Print Capture Receiver Process 506 as brieflydiscussed above in the description of FIG. 5, is a process by which asoftware driver is configured to package and export particular data at aPartner 204 to be transmitted to other third-party systems or theSponsor 202. In particular embodiments, and as mentioned above, theprinter capture functionality may be executed in parallel with the IA210, or any other application running at the Partner 204 organizationcomputing system. In certain embodiments, the particular data packagedand exported via the printer driver may include healthcare data,financial data, insurance data, etc. As will be described in greaterdetail immediately below, the printer driver is operable to generatemultiple file formats (e.g., PDF, JPEG, TIFF, etc.) of the data beingexported.

Included in the present embodiment are the Sponsor 202 and Partner 204,both operatively connected to the Hive 206. It should be understood fromthe discussion herein that Hive 206 is an element of CollaborNet and isa software and/or hardware configuration that creates a secure networkthat manages the assembly, packaging, routing, and delivery ofhealthcare information among and between care delivery organizations.According to one embodiment, and for the purpose of example, a user(e.g., a medical professional) at the Partner 204 organization hasperformed an action involving accessing and/or modifying an electronichealth record. In one embodiment, after the electronic health record hasbeen accessed and/or modified, a clinical summary, or other form ofappropriate content corresponding to the activity performed is generatedand the user may further select to print the content.

In various embodiments, and according to one example, the user maychoose to print the clinical summary to the Sponsor 202 organization oranother third-party system. In particular embodiments, the printerdriver may receive the data to be transmitted from the applicationaccessing the data (e.g., IA 210), or the printer driver may retrievethe data from a particular location in memory (e.g., EHR 226). Accordingto various aspects of the present disclosure, the printer driver mayfurther generate multiple files of various formats that correspond tothe data to be transmitted. In certain embodiments, the printer drivermay translate or map the file format of the native data to the requestedor default file formats for exporting (e.g., PDF, JPEG, TIFF). Accordingto the present embodiment, the generated files are indicated as dataobject 1902. In a particular embodiment, the IA 210 first transmits thedata object 1902 to Hive 206. In one embodiment, the Hive 206 may save acopy of the data object 1902 as associated with the identificationnumber of the Partner 204. In various embodiments, Hive 206 processesthe data 1902 included in the clinical summary. Processing the data 1902included in the clinical summary may include filtering and normalizingthe data 1902. In certain embodiments, Hive 206 forwards the clinicalsummary and associated data 1902 to the Sponsor 202. Once received bythe Sponsor's system 202, the clinical summary and associated data 1902may be used to update the member records within the Sponsor's system202.

In various embodiments, the data objects 1902 may be included asthumbnails in messages sent from the Partner 204 to other systems suchas the Sponsor 202 for making referrals, requesting risk adjustments, orother related tasks.

As will be understood from the discussions herein, the above steps mayoccur automatically. For example, if a user creates a clinical summary,the user may select to “print” the summary and, in response, the systemmay automatically create the files and further transmit the files to theSponsor 202 via Hive 206.

Exemplary Insights Application Decision Tree

Turning now to FIG. 20, exemplary decision tree logic for surfacingcontent into the workflow of a third party system is shown, according tovarious aspects of the present disclosure. In one embodiment, the IAwill query Hive every three seconds (or any appropriate time interval)for available healthcare data for a currently authenticated user (Step2002). In various embodiments, if the API query to Hive returns apatient in context for the user or if the API query to Hive does notreturn a patient in context for the currently authenticated user (Step2004), in either case, the IA may check if a current content alert isalready present on the display (Step 2006). In the case of a patientcurrently in context, and if no current alert already exists on screen,then the IA may surface a new content alert into the workflow of thethird-party system for the patient in context. However, if a currentcontent alert does already exist on screen, then the IA may make adetermination if the current “bubble” (e.g., pop-up notification) isrelated to the same patient as the patient returned in the Hive APIpatient context query (Step 2008). In certain embodiments, if the twopatients are not in fact the same person (e.g., patient IDs do notmatch), then the IA may simply close the existing content alert bubbleand surface a new content alert for the new patient currently in contextas reported by Hive (Steps 2010 and 2012). In particular embodiments, ifthe two patients are in fact the same person (e.g., patient IDs match),then the IA may take no action and the currently surfaced content alertwill remain on screen (Step 2014). According to one aspect of thepresent disclosure, if the original query to the Hive API returned nopatient in context for the currently authenticated user, yet a contentalert does currently exist on screen, then the IA may close the contentalert and remove it from the screen at step 2016 (e.g. user navigatesaway from a patient chart and the currently surfaced content mayautomatically be removed from view as there is no longer correlatedpatient contexts in view).

Referring back to step 2004, and in one embodiment, if the query to Hivereturns patient context and an alert is not currently displayed on thePartner 204 screen (Step 2006), the IA may determine if a “bubble”/alertcorresponding to the patient context has been selected before (Step2030). In various embodiments, if an alert has been selected before, theIA created a timer for the alert, and the IA determines if the timer hasexpired (Step 2032). In one embodiment, if the timer has expired, the IAsurfaces a new content alert at step 2012, and if it has not expiredthen the process may terminate.

Continuing with FIG. 20, from a user's perspective, if the userdismisses the content alert summary at step 2014 (e.g. clicks the closebutton on the alert), then the IA 210 may remove the surfaced contentalert summary and start an acknowledgement timer that is configurable bylocation/organization (Steps 2020 and 2028). However, if the user clickson the content summary alert to view more details, the IA 210 may removethe content alert from screen and open the IA 210 detailed view of themember data, as described previously herein (Steps 2022, 2024, and2026). In one embodiment, this action of viewing more detail will alsoacknowledge the content summary alert and will as well start anacknowledgement timer that is configurable by location/organization(Step 2028). In various embodiments, this timer may expire prior toanother content alert summary being surfaced again for the same patient.

Exemplary Insights Application Visual Aspects and Functionality

Referring now to FIGS. 21-29, exemplary visual aspects of the InsightsApplication (IA) are shown, according to one embodiment of the presentdisclosure. In various embodiments, the IA allows for contextuallyrelevant patient data to be surfaced onto the display of a Partner'scomputing system. As will be described in the discussion on thefollowing figures, a user may interact with the Insights Application viaa touch screen interface, point-and-click display, or any otherappropriate interactive display.

Looking now at FIG. 21, a computer display with a tab 2102 is shown,according to one embodiment. In various embodiments, the tab 2102generally is located at an edge of the display. In the presentembodiment, the tab 2102 is located on the right-hand side of thedisplay and represents the ability for a user to touch, click on, orotherwise select the tab 2102 to access additional functionality of theIA. According to various aspects of the present disclosure, the tab 2102of the IA may be present on the display of a computing device in both anactive and inactive state. For example, when the IA is launched, the tab2102 may be selected to display additional views of the IA. When the IAis inactive, the tab 2102 may be selected to present a sign-in orpassword screen in order for a user to further launch the IA.

FIG. 22 illustrates the exemplary sign-in view pane 2202 of the IA,according to one embodiment. In the present embodiment, the tab 2102from FIG. 21 has been selected by the user of the IA and further hasexposed a view pane that was previously concealed. In one embodiment, ifthe user is not signed into the IA upon selecting the tab 2102, thefirst view pane presented to the user may be the sign-in view pane 2202.In various embodiments, selecting the tab 2102 may result in the sign-inview pane 2202 “sliding” into view on the display (e.g., the panegradually becomes more exposed as it is revealed from outside thedisplay boundaries). In particular embodiments, the sign-in view pane2202 may include a sign-in button 2204 or selectable region within thesign-in view pane 2202 to be presented with a separate view pane forentering security credentials. In some embodiments, upon selecting thesign-in button 2204, the sign-in view pane 2202 may not change butinstead a graphic or visual may be presented within the sign-in viewpane 2202.

Looking now at FIG. 23, in one embodiment, and in response to a userselecting the sign-in button 2204, a password view pane 2302 ispresented on the display. In the present disclosure, the password viewpane 2302 includes a 12-button keypad 2304 for entering usercredentials. According to various aspects of the present disclosure, auser of the IA may use the 12-button keypad to enter a passwordincluding a particular number of digits (e.g., the number of digits mayvary based on preferred security), the user may enter a passwordincluding a combination of keystrokes (e.g., numbers, letters, andsymbols), or the user may select and drag on the password view pane todraw a unique pattern that resembles his/her sign-in credential.

Proceeding now to FIG. 24, a pop-up alert 2402 (e.g., a notification or“button”) is shown, according to one aspect of the present disclosure.In various embodiments, the IA is operable to receive patient data fromHive in response to electronic health record activity occurring atvarious third-party systems that are associated with a particularpatient or in response to a particular chart being open on the presentsystem (not shown). In one embodiment, and as a result of the electronichealth record activity being detected, the pop-up alert 2402 may bedisplayed on the user's display. In a particular embodiment, the pop-upalert 2402 may be displayed as a result of the user's IA, in the presentembodiment, accessing a particular patients electronic health records ona separate display or device or on the present display of the device. Asseen in the present embodiment, the pop-up alert 2402 may includepatient data such as care gaps 2404, coding gaps 2406, and generalalerts 2408. In various embodiments, the pop-up alert 2402 includesnumber indicators for displaying how many care gaps 2404, coding gaps2406, and general alerts 2408 have been detected, for example thenumbers 2, 7, and 7 representing the previously listed categories,respectively. According to various aspects of the present disclosure,selecting the pop-up alert 2402 may result in the IA 210 presenting amore detailed pane including the health care data corresponding to theindicated gaps. In some embodiments, an alert 2402 relating to aparticular patient may be surfaced onto the screen at a Partner if theuser at the Partner is viewing an open electronic health record relatingto the particular patient, if the user is viewing an electronic healthrecord relating to another patient, or if the user is not currentlyviewing any particular electronic health record.

Turning now to FIG. 25, a patient code gap pane 2502 is shown, accordingto one embodiment. In various embodiments, the patient code gap pane2502 includes health care data missing from, or otherwise inconsistentwith, the Partner's EHR system, thereby resulting in a code gap. In thepresent embodiment, a coding gap 2504 is shown and includes healthcareinformation related to Diabetes Mellitus. In a particular embodiment,information associated with the coding gap 2504 may include date ofservice 2506, format 2508, code 2510, and year/month 2512. In someembodiments, the information associated with the coding gap istransmitted to the IA from the Hive, where the information was stored ina context table similar to the table shown in FIG. 13. In oneembodiment, the user may decide to ignore the coding gap 2504, or theuser may record the coding gap 2504 information by selecting a recordactivity button 2514. According to various aspects of the presentdisclosure, selecting the record activity button 2514 may result in theIA updating the EHR system or particular electronic health record toinclude the data from the coding gap 2504.

Referring now to FIG. 26, an exemplary profile pane 2602 correspondingto a particular patient is shown, according to one embodiment. In oneembodiment, the profile pane 2602 corresponding to a particular patientallows for the user at the Partner to navigate particular aspects of theparticular patient's health history and recent health-related activity.As shown in the present embodiment, the profile pane 2602 may includegeneral information relating to the patient such as name, date of birth,telephone number, etc., shown at 2604. In addition to the generalinformation shown at 2604, the profile pane 2602 may further includeinformation such as the particular patient's insurance provider (e.g.,Payer: BCBSF) and his/her member identification number associated withthat insurance provider (e.g., Member ID: H2222222222), as shown at2606. In various embodiments, the profile pane 2602 includes selectablebuttons/regions such as a View Activity Timeline button 2608 and a ViewEligibility & Benefits button 2610. According to various aspects of thepresent disclosure, a user at the Partner may select either of thesebuttons (2608 and/or 2610) to be presented with additional informationrelating to the particular patient's activity timeline or insuranceeligibility/benefits, or the user may be presented with an entirely newview pane. In certain embodiments, the user at the Partner 204organization may determine particular risk factors associated with theparticular patient, and the user may indicate them accordingly at theOther Risk Factors menu 2612. In various embodiments, indicatingparticular risk factors for a particular patient may result in aclinical summary (or other appropriate form of healthcare data) beingtransmitted to the patient's corresponding Sponsor 202 for a riskadjustment.

Turning now to FIG. 27, an exemplary Eligibility Summary pane 2702 isshown, according to one embodiment. In various embodiments, andmentioned briefly above in the discussion of FIG. 26, in response toselecting the View Eligibility & Benefits button 2610, the user at thePartner 204 organization is presented with a new view pane includingdetailed insurance information associated with the particular patient.According to various aspects of the present disclosure, the EligibilitySummary pane 2702, in response to selecting the View Eligibility &Benefits button 2610, may visually appear to slide and overlay theprofile pane 2602 (or any other previously displayed view pane). In aparticular embodiment, the Eligibility Summary pane 2702 includes theinsurance and benefit information a user at the Partner 204 organizationmay need to know in order to provide effective and efficient care.

For example, shown at 2704 is general information relating to theparticular patient, such as his/her insurance plan, his/hercorresponding member ID, his/her coverage date range, and his/her lastdate of service. The information at 2704 is generally presented to theuser, however, in some embodiments the information may be included in adropdown menu or otherwise concealed until selected. As shown in thepresent embodiment, detailed and specific eligibility informationrelating to the particular patient is included in the PatientInformation 2706 and Coverage and Benefits 2708 sections of theEligibility Summary pane 2702. Looking at the Patient Information 2706section, the user may view specific details corresponding to thepatient's eligibility such as subscriber information, plan/productinformation, payor details, and provider details. Referring to theCoverage and Benefits 2708 section, the user may view specific detailscorresponding to surgical coverage, health benefit plan coverage, etc.The information included in the Patient Information 2706 and Coverageand Benefits 2708 sections provide the user with on-demand access todetails regarding the particular patient's health care eligibility, butthat information may not be necessary to view during every visit.

Turning now to FIG. 28, an exemplary schedule pane 2802 is shown,according to one embodiment. In various embodiments, the schedule pane2802 corresponds to the Partner's 204 scheduled appointments for aparticular day, week, month, etc. In a particular embodiment, theschedule pane 2802 may present the scheduled appointments inchronological order and categorized according to the particular hour ofthe appointments. For example, the schedule pane 2802 includesappointments for Patient #1, Patient #2, and Patient #3, beginning at7:00 AM, 7:30 AM, and 7:30 AM, respectively, each organized into a 7:00AM time slot 2804. Furthermore, in the present embodiment, Patient #4and Patient #5 have appointments organized into an 11:00 AM time slot2806, each appointment beginning at 11:30 AM and 11:15 AM, respectively.In particular embodiments, the appointments within each time slot (2804and 2806) may be presented in other measures of priority, such as lengthof appointment, if the patient has arrived at the Partner 204organization, or if there is an error in the particular patient's healthrecords.

Turning now to FIG. 29, an exemplary record activity pane 2902 is shown,according to one embodiment. In the present embodiment, a user at thePartner 204 organization may record or report certain health relatedactivity associated with a particular patient to a Sponsor 202, Hive206, or another appropriate third-party system. According to variousaspects of the present disclosure, the user may select a Find in Files2904 option, an Attach from EHR 2906 option, or any other appropriatemethod for selecting particular portions (if not all) of electronichealth data to record or report. In various embodiments, the recordactivity pane 2902 may correspond to the “printer capture” processdescribed in the discussion of FIG. 19. For example, the recorded filesor EHR data may be transmitted to Hive 206 and further to the Sponsor202 for reporting risk adjustments, submitting insurance claims, etc.

From the foregoing, it will be understood that various aspects of theprocesses described herein are software processes that execute oncomputer systems that form parts of the system. Accordingly, it will beunderstood that various embodiments of the system described herein aregenerally implemented as specially-configured computers includingvarious computer hardware components and, in many cases, significantadditional features as compared to conventional or known computers,processes, or the like, as discussed in greater detail herein.Embodiments within the scope of the present disclosure also includecomputer-readable media for carrying or having computer-executableinstructions or data structures stored thereon. Such computer-readablemedia can be any available media that can be accessed by a computer, ordownloadable through communication networks. By way of example, and notlimitation, such computer-readable media can comprise various forms ofdata storage devices or media such as RAM, ROM, flash memory, EEPROM,CD-ROM, DVD, or other optical disk storage, magnetic disk storage, solidstate drives (SSDs) or other data storage devices, any type of removablenon-volatile memories such as secure digital (SD), flash memory, memorystick, etc., or any other medium which can be used to carry or storecomputer program code in the form of computer-executable instructions ordata structures and which can be accessed by a general purpose computer,special purpose computer, specially-configured computer, mobile device,etc.

When information is transferred or provided over a network or anothercommunications connection (either hardwired, wireless, or a combinationof hardwired or wireless) to a computer, the computer properly views theconnection as a computer-readable medium. Thus, any such a connection isproperly termed and considered a computer-readable medium. Combinationsof the above should also be included within the scope ofcomputer-readable media. Computer-executable instructions comprise, forexample, instructions and data that cause a general-purpose computer,special purpose computer, or special purpose-processing device such as amobile device processor to perform one specific function or a group offunctions.

Those skilled in the art will understand the features and aspects of asuitable computing environment in which aspects of the disclosure may beimplemented. Although not required, some of the embodiments of theclaimed systems may be described in the context of computer-executableinstructions, such as program modules or engines, as described earlier,being executed by computers in networked environments. Such programmodules are often reflected and illustrated by flow charts, sequencediagrams, exemplary screen displays, and other techniques used by thoseskilled in the art to communicate how to make and use such computerprogram modules. Generally, program modules include routines, programs,functions, objects, components, data structures, application programminginterface (API) calls to other computers whether local or remote, etc.that perform particular tasks or implement particular defined datatypes, within the computer. Computer-executable instructions, associateddata structures and/or schemas, and program modules represent examplesof the program code for executing steps of the methods disclosed herein.The particular sequence of such executable instructions or associateddata structures represents examples of corresponding acts forimplementing the functions described in such steps.

Those skilled in the art will also appreciate that the claimed and/ordescribed systems and methods may be practiced in network computingenvironments with many types of computer system configurations,including personal computers, smartphones, tablets, hand-held devices,multi-processor systems, microprocessor-based or programmable consumerelectronics, networked PCs, minicomputers, mainframe computers, and thelike. Embodiments of the claimed system are practiced in distributedcomputing environments where tasks are performed by local and remoteprocessing devices that are linked (either by hardwired links, wirelesslinks, or by a combination of hardwired or wireless links) through acommunications network. In a distributed computing environment, programmodules may be located in both local and remote memory storage devices.

An exemplary system for implementing various aspects of the describedoperations, which is not illustrated, includes a computing deviceincluding a processing unit, a system memory, and a system bus thatcouples various system components including the system memory to theprocessing unit. The computer will typically include one or more datastorage devices for reading data from and writing data to. The datastorage devices provide nonvolatile storage of computer-executableinstructions, data structures, program modules, and other data for thecomputer.

Computer program code that implements the functionality described hereintypically comprises one or more program modules that may be stored on adata storage device. This program code, as is known to those skilled inthe art, usually includes an operating system, one or more applicationprograms, other program modules, and program data. A user may entercommands and information into the computer through keyboard, touchscreen, pointing device, a script containing computer program codewritten in a scripting language or other input devices (not shown), suchas a microphone, etc. These and other input devices are often connectedto the processing unit through known electrical, optical, or wirelessconnections.

The computer that effects many aspects of the described processes willtypically operate in a networked environment using logical connectionsto one or more remote computers or data sources, which are describedfurther below. Remote computers may be another personal computer, aserver, a router, a network PC, a peer device or other common networknode, and typically include many or all of the elements described aboverelative to the main computer system in which the systems are embodied.The logical connections between computers include a local area network(LAN), a wide area network (WAN), virtual networks (WAN or LAN), andwireless LANs (WLAN) that are presented here by way of example and notlimitation. Such networking environments are commonplace in office-wideor enterprise-wide computer networks, intranets, and the Internet.

When used in a LAN or WLAN networking environment, a computer systemimplementing aspects of the system is connected to the local networkthrough a network interface or adapter. When used in a WAN or WLANnetworking environment, the computer may include a modem, a wirelesslink, or other mechanisms for establishing communications over the widearea network, such as the Internet. In a networked environment, programmodules depicted relative to the computer, or portions thereof, may bestored in a remote data storage device. It will be appreciated that thenetwork connections described or shown are exemplary and othermechanisms of establishing communications over wide area networks or theInternet may be used.

While various aspects have been described in the context of a preferredembodiment, additional aspects, features, and methodologies of theclaimed systems will be readily discernible from the description herein,by those of ordinary skill in the art. Many embodiments and adaptationsof the disclosure and claimed systems other than those herein described,as well as many variations, modifications, and equivalent arrangementsand methodologies, will be apparent from or reasonably suggested by thedisclosure and the foregoing description thereof, without departing fromthe substance or scope of the claims. Furthermore, any sequence(s)and/or temporal order of steps of various processes described andclaimed herein are those considered to be the best mode contemplated forcarrying out the claimed systems. It should also be understood that,although steps of various processes may be shown and described as beingin a preferred sequence or temporal order, the steps of any suchprocesses are not limited to being carried out in any particularsequence or order, absent a specific indication of such to achieve aparticular intended result. In most cases, the steps of such processesmay be carried out in a variety of different sequences and orders, whilestill falling within the scope of the claimed systems. In addition, somesteps may be carried out simultaneously, contemporaneously, or insynchronization with other steps.

Additional Aspects

Various aspects of the present systems and methods will now bedescribed. It will be understood by one of ordinary skill in the artthat any of the aspects below may incorporate and include any otheraspects mentioned below or features described herein. Therefore, theaspects below should be understood to include any combination of aspectsand should not be limited to the combinations presented below. Forexample, although the second aspect includes the computer system of thefirst aspect, it may also include features of the twenty-sixth aspect,the first aspect, or the hundredth aspect.

According to a first aspect, the present systems and methods, in variousembodiments, may include a distributed architecture system forreconciling healthcare information between disparate sources,comprising: A) a surfacing application for presenting health recordrelated alerts on a display in conjunction with electronic healthrecords, the surfacing application operatively connected to at least onecomputing device at a healthcare clinic including the display; B) atleast one patient context sensor operatively connected to a clinichealth record database comprising electronic health records associatedwith a particular set of patients and configured to monitor interactionswith the clinic health record database at preconfigured intervals todetect a trigger event, the trigger event corresponding to the at leastone computing device electronically accessing one or more of theelectronic health records; C) at least one third-party context sensoroperatively connected to a remote data repository and configured to pollthe remote data repository for third-party analytic data from a sponsorsystem, the third-party analytic data comprising healthcare informationcorresponding to at least a subset of the particular set of patients;and D) a cloud-based micro-services system operatively connected to theat least one third-party context sensor and the at least one patientcontext sensor, the cloud-based micro-services system comprising atleast one micro-services database and one or more processors configuredfor: 1) in response to the at least one third-party context sensormonitoring the remote data repository, receiving the third-partyanalytic data comprising the healthcare information from the at leastone third-party context sensor; 2) associating an identification numberwith each patient included in the subset of the particular set ofpatients; 3) in response to the at least one patient context sensordetecting a particular trigger event, receiving accessed chart data fromthe at least one context sensor, the accessed chart data correspondingto a particular patient's electronic health record; 4) determininghealthcare gap information between the received accessed chart data andthe healthcare information with a corresponding identification number,wherein the healthcare gap information comprises healthcare data otherthan the accessed chart data; and 5) transmitting the healthcare gapinformation to the surfacing application, wherein the healthcare gapinformation is surfaced onto the display of the at least one computingdevice in the form of an alert.

According to a second aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the particular trigger eventcomprises the particular accessed electronic health record beingaccessed by the at least one computing device.

According to a third aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the clinic health recorddatabase and the cloud-based micro-services system are physicallyseparated.

According to a fourth aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the at least one patientcontext sensor is configured to detect the particular trigger event byinteracting with at least one event notification system applicationprogramming interface of the at least one computing device.

According to a fifth aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the at least one patientcontext sensor is configured to detect the particular trigger event byaccessing data included in the clinic health record database.

According to a sixth aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the at least one patientcontext sensor receives a list of identifiers from the cloud-basedmicro-services system prior to detecting the particular trigger event.

According to a seventh aspect, the distributed architecture system ofthe sixth aspect or any other aspect, wherein the list of identifiers isextracted from the third-party analytic data of the sponsor.

According to an eighth aspect, the distributed architecture system ofthe seventh aspect, or any other aspect, wherein the sponsor is ahealthcare insurance provider.

According to a ninth aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the at least onemicro-services database stores the health records in a normalizedcanonical format.

According to a tenth aspect, the distributed architecture system of thefirst aspect or any other aspect, wherein the at least onemicro-services database is a NoSQL Key-Value database.

According to an eleventh aspect, the distributed architecture system ofthe first aspect or any other aspect, wherein prior to transmitting thehealthcare gap information to the at least one computing device, thehealthcare gap information is stored in a context table at thecloud-based micro-services system, wherein the context table isaccessible by one or more additional computing devices at healthcareclinics associated with the particular patient.

According to a twelfth aspect, the distributed architecture system ofthe first aspect or any other aspect, wherein the healthcare gapinformation is transmitted to the at least one computing device via amicro-services application programming interface.

According to a thirteenth aspect, the present systems and methods mayinclude, in various embodiments, a method for reconciling healthcareinformation between disparate sources in a distributed architecturesystem, the method comprising the steps of: A) monitoring a clinichealth record database at preconfigured intervals via at least onepatient context sensor to detect a trigger event corresponding to atleast one computing device electronically accessing one or more of theelectronic health records stored at the clinic health record database,the at least one patient context sensor operatively connected to theclinic health record database; B) polling a remote data repository viaat least one third-party context sensor operatively connected to theremote data repository for third-party analytic data from a sponsorsystem, the third-party analytic data comprising healthcare informationcorresponding to at least a subset of a particular set of patients; andC) in response to the at least one third-party context sensor pollingthe remote data repository, receiving at a cloud-based micro-servicessystem the third-party analytic data comprising the healthcareinformation from the third-party context sensor, the cloud-basedmicro-services system operatively connected to the at least onethird-party context sensor and the at least one patient context sensor,the cloud-based micro-services system comprising at least onemicro-services database and one or more processors configured for: 1)associating an identification number with each patient included in thesubset of the particular set of patients; 2) in response to the at leastone patient context sensor detecting a particular trigger event,receiving accessed chart data from the at least one context sensor, theaccessed chart data corresponding to a particular patient's electronichealth record; 3) determining healthcare gap information between thereceived accessed chart data and the healthcare information with acorresponding identification number, wherein the healthcare gapinformation comprises healthcare data other than the accessed chartdata; and 4) transmitting the healthcare gap information to a surfacingapplication installed on the at least one computing device, wherein thehealthcare gap information is surfaced onto the display of the at leastone computing device in the form of an alert.

According to a fourteenth aspect, the method of the thirteenth aspect orany other aspect, wherein the particular trigger event comprises theparticular accessed electronic health record being accessed by the atleast one computing device.

According to a fifteenth aspect, the method of the thirteenth aspect orany other aspect, wherein the clinic health record database and thecloud-based micro-services system are physically separated.

According to a sixteenth aspect, the method of the thirteenth aspect orany other aspect, wherein the at least one patient context sensor isconfigured to detect the particular trigger event by interacting with atleast one event notification system application programming interface ofthe at least one computing device.

According to a seventeenth aspect, the method of the thirteenth aspector any other aspect, wherein the at least one patient context sensor isconfigured to detect the particular trigger event by accessing dataincluded in the clinic health record database.

According to an eighteenth aspect, the method of the thirteenth aspector any other aspect, wherein the at least one patient context sensorreceives a list of identifiers from the cloud-based micro-servicessystem prior to detecting the particular trigger event.

According to a nineteenth aspect, the method of the eighteenth aspect orany other aspect, wherein the list of identifiers is extracted from thethird-party analytic data of the sponsor.

According to a twentieth aspect, the method of the nineteenth aspect orany other aspect, wherein the sponsor is a healthcare insuranceprovider.

According to a twenty-first aspect, the method of the thirteenth aspector any other aspect, wherein the at least one micro-services databasestores the health records in a normalized canonical format.

According to a twenty-second aspect, the method of the thirteenth aspector any other aspect, wherein the at least one micro-services database isa NoSQL Key-Value database.

According to a twenty-third aspect, the method of the thirteenth aspector any other aspect, wherein prior to transmitting the healthcare gapinformation to the at least one computing device, the healthcare gapinformation is stored in a context table at the cloud-basedmicro-services system, wherein the context table is accessible by one ormore additional computing devices at healthcare clinics associated withthe particular patient.

According to a twenty-fourth aspect, the method the thirteenth aspect orany other aspect, wherein the healthcare gap information is transmittedto the at least one computing device via a micro-services applicationprogramming interface.

According to a twenty-fifth aspect, the present systems and methods mayinclude, in various embodiments, a distributed architecture system fordetecting healthcare gap information across disparate sources,comprising at least one sensor operatively connected to a clinic healthrecord system database and a cloud-based micro-services system, the atleast one sensor comprising one or more application programminginterfaces protected by a firewall, the at least one sensor configuredto: A) receive, from the cloud-based micro-services system,identification information for a list of patients associated with the atleast one third-party system; B) store at least a portion of theidentification information at the at least one sensor; C) monitor theclinic health record system database to detect a trigger event, thetrigger event corresponding to a computing system electronicallyaccessing a particular electronic health record at the clinic healthrecord system database of at least one of the patients included in thelist of patients stored at the at least one sensor; and D) in responseto detecting the trigger event, transmit accessed chart data to thecloud-based micro-services system, whereby the cloud-basedmicro-services system transmits context data relating to particularhealthcare gap information to a surfacing application to be surfacedonto a display.

According to a twenty-sixth aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the at least onethird-party system is an insurance provider.

According to a twenty-seventh aspect, the distributed architecturesystem of the twenty-fifth aspect or any other aspect, wherein the atleast one third-party system is a healthcare providing organization.

According to a twenty-eighth aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the accessedchart data comprises a clinic health record system database identifierand particular electronic health record data.

According to a twenty-ninth aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the triggerevent comprises one or more events selected from the group comprisingopening the particular electronic health record, initiating aprescription order, creating a new electronic health record chart, anddigitally signing an encounter note.

According to a thirtieth aspect, the distributed architecture system ofthe twenty-fifth aspect or any other aspect, wherein prior to receivingthe identification information for the list of patients, the at leastone sensor is configured to transmit a request to the cloud-basedmicro-services system for the identification information according topredetermined time intervals.

According to a thirty-first aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the healthcaregap information is surfaced onto the display by presenting thehealthcare gap information in the form of an alert notification.

According to a thirty-second aspect, the distributed architecture systemof the thirty-first aspect or any other aspect, wherein the alertnotification is presented by sliding the alert notification from outsidethe display boundaries.

According to a thirty-third aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the at least onemicro-services database stores the healthcare data in a normalizedcanonical format.

According to a thirty-fourth aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the at least onemicro-services database is a NoSQL Key-Value database.

According to a thirty-fifth aspect, the distributed architecture systemof the twenty-fifth aspect or any other aspect, wherein the triggerevent comprises intercepting an application programming interface callfor the particular electronic health record, detecting manipulation ofthe particular electronic health record at the clinic health recordsystem database, or detecting the particular electronic health recordbeing presented on the display.

According to a thirty-sixth aspect, the distributed architecture systemof the thirty-fifth aspect or any other aspect, wherein the particularelectronic health record being presented on the display is detected viascreen scraping.

According to a thirty-seventh aspect, the present systems and methodsmay include, in various embodiments, trigger-based method for detectinghealthcare gap information across disparate sources, comprising thesteps of: A) receiving via at least one sensor operatively connected toa clinic health record system database, from a cloud-basedmicro-services system, identification information for a list of patientsassociated with at least one third-party system, wherein the at leastone sensor comprises one or more application programming interfacesprotected by a firewall; B) storing at least a portion of theidentification information at the at least one sensor; C) monitoring theclinic health record system database to detect a trigger event, thetrigger event corresponding to a computing system electronicallyaccessing a particular electronic health record at the clinic healthrecord system database of at least one of the patients included in thelist of patients stored at the at least one sensor; and D) in responseto detecting the trigger event, transmitting accessed chart data to thecloud-based micro-services system, whereby the cloud-basedmicro-services system transmits to the at least one computing systemcontext data relating to particular healthcare gap information to besurfaced onto the display.

According to a thirty-eighth aspect, the method of the thirty-seventhaspect or any other aspect, wherein the at least one third-party systemis an insurance provider.

According to a thirty-ninth aspect, the method of the thirty-seventhaspect or any other aspect, wherein the at least one third-party systemis a healthcare providing organization.

According to a fortieth aspect, the method of the thirty-seventh aspector any other aspect, wherein the accessed chart data comprises a clinichealth record system database identifier and particular electronichealth record data.

According to a forty-first aspect, the method of the thirty-seventhaspect or any other aspect, wherein the trigger event comprises one ormore events selected from the group comprising opening the particularelectronic health record, initiating a prescription order, creating anew electronic health record chart, and digitally signing an encounternote.

According to a forty-second aspect, the method of the thirty-seventhaspect or any other aspect, wherein prior to receiving theidentification information for the list of patients, the at least onesensor is configured to transmit a request to the cloud-basedmicro-services system for the identification information according topredetermined time intervals.

According to a forty-third aspect, the method of the thirty-seventhaspect or any other aspect, wherein the healthcare gap information issurfaced onto the display by presenting the healthcare gap informationin the form of an alert notification.

According to a forty-fourth aspect, the method of the forty-third aspector any other aspect, wherein the alert notification is presented bysliding the alert notification from outside the display boundaries.

According to a forty-fifth aspect, the method of the thirty-seventhaspect or any other aspect, wherein the at least one micro-servicesdatabase stores the healthcare data in a normalized canonical format.

According to a forty-sixth aspect, the method of the thirty-seventhaspect or any other aspect, wherein the at least one micro-servicesdatabase is a NoSQL Key-Value database.

According to a forty-seventh aspect, the method of the thirty-seventhaspect or any other aspect, wherein the trigger event comprisesintercepting an application programming interface call for theparticular electronic health record, detecting manipulation of theparticular electronic health record at the clinic health record systemdatabase, or detecting the particular electronic health record beingpresented on the display.

According to a forty-eighth aspect, the method of the forty-seventhaspect or any other aspect, wherein the particular electronic healthrecord being presented on the display is detected via screen scraping.

According to a forty-ninth aspect, the present systems and methods mayinclude, in various embodiments, a distributed architecture system fortracking patient information across a plurality of disparate third-partycomputing systems, comprising: A) one or more sensors connected to theplurality of disparate third-party computing systems, each of the one ormore sensors comprising on or more application programming interfacesprotected by a firewall for electronically communicating the patientinformation between the plurality of disparate third-party computingsystems; and B) a cloud-based micro-services system in operativecommunication with the one or more sensors, the cloud-basedmicro-services system comprising one or more processors configuredto: 1) receive a request from a first sensor associated with a firstthird-party computing system to receive electronic health recordinformation corresponding to a particular patient identifier associatedwith a particular patient, the first third-party computing systemassociated with a particular system identifier; 2) match the particularpatient identifier with corresponding electronic health recordinformation and corresponding member information; 3) store theparticular patient identifier and corresponding member informationassociated with the electronic health record information; and 4) uponreceiving additional healthcare information from a second sensorassociated with a second third-party computing system associated with asecond particular system identifier, transmit to the first third-partycomputing system at least a portion of the matched electronic healthrecord information and member information.

According to a fiftieth aspect, the system of the forty-ninth aspect orany other aspect, wherein at least one of the plurality of disparatethird-party computing systems is an insurance provider.

According to a fifty-first aspect, the system of the forty-ninth aspector any other aspect, wherein the electronic health record information isnormalized in a canonical format.

According to a fifty-second aspect, the system of the forty-ninth aspector any other aspect, wherein the additional healthcare informationcomprises healthcare gap information.

According to a fifty-third aspect, the system of the forty-ninth aspector any other aspect, wherein the one or more processors operate inapproximately real-time.

According to a fifty-fourth aspect, the system of the forty-ninth aspector any other aspect, wherein the at least a portion of the matchedelectronic health record information and member information istransmitted to a surfacing application at the first third-partycomputing system to be presented as an alert on a display.

According to a fifty-fifth aspect, the system of the forty-ninth aspector any other aspect, wherein the particular patient identifier comprisesMedicaid identification numbers.

According to a fifty-sixth aspect, the system of the forty-ninth aspector any other aspect, wherein the one or more third-partycomputing-system identifier comprise National Provider Identifier(NPIs).

According to a fifty-seventh aspect, the present systems and methods mayinclude, in various embodiments, a computer-implemented method fortracking patient information across a plurality of disparate third-partycomputing systems via a distributed architecture, comprising the stepsof: A) receiving, at a cloud-based micro-services system in operativecommunication with one or more sensors connected to the plurality ofdisparate third-party computing systems, a request from a first sensorassociated with a first third-party computing system to receiveelectronic health record information corresponding to a particularpatient identifier associated with a particular patient, the firstthird-party computing system associated with a particular systemidentifier; B) matching the particular patient identifier withcorresponding electronic health record information and correspondingmember information; C) storing the particular patient identifier andcorresponding member information associated with the electronic healthrecord information; and D) upon receiving additional healthcareinformation from a second sensor associated with a second third-partycomputing system associated with a second particular system identifier,transmitting to the first third-party computing system at least aportion of the matched electronic health record information and memberinformation.

According to a fifty-eighth aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein at least one ofthe plurality of disparate third-party computing systems is an insuranceprovider.

According to a fifty-ninth aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein the electronichealth record information is normalized in a canonical format.

According to a sixtieth aspect, the computer-implemented method of thefifty-seventh aspect or any other aspect, wherein the additionalhealthcare information comprises healthcare gap information.

According to a sixty-first aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein the one or moreprocessors operate in approximately real-time.

According to a sixty-second aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein the at least aportion of the matched electronic health record information and memberinformation is transmitted to a surfacing application at the firstthird-party computing system to be presented as an alert on a display.

According to a sixty-third aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein the particularpatient identifier comprises Medicaid identification numbers.

According to a sixty-fourth aspect, the computer-implemented method ofthe fifty-seventh aspect or any other aspect, wherein the one or morethird-party computing-system identifier comprise National ProviderIdentifier (NPIs).

According to a sixty-fifth aspect, the present systems and methodsinclude a distributed architecture system for detecting healthcare gapinformation across disparate sources, comprising a cloud-basedmicro-services system operatively connected to at least one sensor and asurfacing application and comprising at least one micro-servicesdatabase including electronic health records received from at least onethird-party system and at least one processor configured to: A) receivefrom the at least one sensor, particular accessed electronic healthrecord data associated with a particular accessed electronic healthrecord and an identifier associated with a clinic health record systemdatabase in response to the at least one sensor detecting a particulartrigger event; B) in response to receiving the particular accessedelectronic health record data and the identifier, retrieve one or moreelectronic health records matching at least portions of the particularaccessed electronic health record data from the at least onemicro-services database based at least in part on the identifier; C)compare the particular accessed electronic health record data to the oneor more electronic health records and store healthcare gap informationin a context table accessible by the surfacing application via amicro-services application programming interface, wherein the healthcaregap information comprises information other than the informationincluded in the particular accessed electronic health record data; D)receive, from the surfacing application at predetermined intervals,queries for the healthcare gap information; and E) automaticallytransmit the healthcare gap information to the surfacing application,wherein the surfacing application modifies a display of at least onecomputing system by surfacing the healthcare gap information, whereinsurfacing the healthcare gap information comprises: i) surfacing analert, the alert selectable by a user at the surfacing application andcomprising a partial record of the healthcare gap information; and ii)in response to the user selecting the alert, surfacing a complete recordof the healthcare gap information, wherein the complete record of thehealthcare gap information replaces the alert on the display.

According to a sixty-sixth aspect, the system of the sixty-fifth aspector any other aspect, wherein the particular trigger event comprises theparticular accessed electronic health record being accessed by the atleast one computing system.

According to a sixty-seventh aspect, the system of the sixty-fifthaspect or any other aspect, wherein the clinic health record systemdatabase and the cloud-based micro-services system are physicallyseparated.

According to a sixty-eight aspect, the system of the sixty-fifth aspector any other aspect, wherein the at least one sensor is configured todetect the particular trigger event by interacting with at least oneevent notification system application programming interface of the atleast one computing system.

According to a sixty-ninth aspect, the system of the sixty-fifth aspector any other aspect, wherein the at least one sensor is configured todetect the particular trigger event by at least one of the groupcomprising accessing data included in the clinic health record systemdatabase, intercepting an application programming interface call for theparticular electronic health record, and screen scraping the electronichealth record data from the display.

According to a seventieth aspect, the system of the sixty-fifth aspector any other aspect, wherein the at least one sensor receives a list ofidentifiers from the cloud-based micro-services system prior todetecting the particular trigger event.

According to a seventy-first aspect, the system of the seventieth aspector any other aspect, wherein the identifier associated with the clinichealth record system database is included in the list of identifiers.

According to a seventy-second aspect, the system of the seventy-firstaspect or any other aspect, wherein the cloud-based micro-servicessystem initially receives the list of identifiers from a sponsororganization's analytics system.

According to a seventy-third aspect, the system of the sixty-fifthaspect or any other aspect, wherein the at least one micro-servicesdatabase stores the health records in a normalized canonical format.

According to a seventy-fourth aspect, the system of the sixty-fifthaspect or any other aspect, wherein the at least one micro-servicesdatabase is a NoSQL Key-Value database.

According to a seventy-fifth aspect, computer-implemented method forsurfacing healthcare gap information detected between disparate sourcesvia a distributed computer architecture system, the computer-implementedmethod comprising the steps of: A) receiving, at a cloud-basedmicro-services system, from at least one sensor operatively connected toa clinic health record system database and in response to the at leastone sensor detecting a particular trigger event associated with aparticular accessed electronic health record, particular accessedelectronic health record data associated with the particular accessedelectronic health record and an identifier associated with the clinichealth record system database, wherein the at least one sensor isconfigured to poll the clinic health record system database atpreconfigured intervals to detect the particular trigger event and theparticular trigger event comprises electronic access to the particularaccessed electronic health record; B) in response to receiving theparticular accessed electronic health record data and the identifier,retrieving, via the cloud-based micro-services system, one or moreelectronic health records matching at least portions of the particularaccessed electronic health record data from at least one micro-servicesdatabase operatively connected to the cloud-based micro-services systembased at least in part on the identifier; C) comparing, via thecloud-based micro-services system, the particular accessed electronichealth record data to the one or more electronic health records toidentify healthcare gap information and storing the healthcare gapinformation in a context table accessible by a surfacing applicationoperatively connected to the cloud-based micro-services system via amicro-services application programming interface, wherein the healthcaregap information comprises information other than the informationincluded in the particular accessed electronic health record data; D)receiving, from the surfacing application at predetermined intervals,queries from the surfacing application for the healthcare gapinformation; and E) automatically transmitting the healthcare gapinformation to the surfacing application, wherein the surfacingapplication modifies a display of at least one computing system bysurfacing the healthcare gap information, wherein surfacing thehealthcare gap information comprises: i) surfacing an alert, the alertselectable by a user at the surfacing application and comprising apartial record of the healthcare gap information; and ii) in response tothe user selecting the alert, surfacing a complete record of thehealthcare gap information, wherein the complete record of thehealthcare gap information replaces the alert on the display.

According to a seventy-sixth aspect, the computer-implemented method ofthe seventy-fifth aspect or any other aspect, wherein the particulartrigger event comprises the particular accessed electronic health recordbeing opened on the display.

According to a seventy-seventh aspect, the computer-implemented methodof the seventy-fifth aspect or any other aspect, wherein the clinichealth record system database and the cloud-based micro-services systemare physically separated.

According to a seventy-eight aspect, the computer-implemented method ofthe seventy-fifth aspect or any other aspect, wherein the at least onesensor is configured to detect the particular trigger event byinteracting with at least one event notification system applicationprogramming interface of the at least one computing system.

According to a seventy-ninth aspect, the computer-implemented method ofthe seventy-fifth aspect or any other aspect, wherein the at least onesensor is configured to detect the particular trigger event by at leastone of the group comprising accessing data included in the clinic healthrecord system database, intercepting an application programminginterface call for the particular electronic health record, and screenscraping the electronic health record data from the display.

According to an eighth aspect, the computer-implemented method of theseventy-fifth aspect or any other aspect, wherein the at least onesensor receives a list of identifiers from the cloud-basedmicro-services system prior to detecting the particular trigger event.

According to an eighty-first aspect, the computer-implemented method ofthe eightieth aspect or any other aspect, wherein the particularaccessed electronic health record is associated with an identifierincluded in the list of identifiers.

According to an eighty-second aspect, the computer-implemented method ofthe eighty-first aspect or any other aspect, wherein the cloud-basedmicro-services system initially receives the list of identifiers from asponsor organization's analytics system.

According to an eighty-third aspect, the computer-implemented method ofthe seventy-fifth aspect or any other aspect, wherein the at least onemicro-services database stores the one or more electronic health recordsin a normalized canonical format.

According to an eighty-fourth aspect, the computer-implemented method ofthe seventy-fifth aspect or any other aspect, wherein the at least onemicro-services database is a NoSQL Key-Value database.

According to an eighty-fifth aspect, a system for automaticallyexecuting workflows in a distributed architecture, comprising: A) atleast one sensor operatively connected to a clinic health record systemdatabase, the at least one sensor configured to monitor the clinichealth record system database at preconfigured intervals to detect atrigger event, the trigger event corresponding to electronic access toan electronic health record; and B) a cloud-based micro-services systemoperatively connected to the at least one sensor and comprising at leastone micro-services database including electronic health records receivedfrom at least one third-party system, and a set of predeterminedinstructions for responding to the trigger event, wherein: i) thecloud-based micro-services system receives a request from the at leastone sensor requesting the set of predetermined instructions forresponding to the trigger event; ii) the cloud-based micro-servicessystem transmits the set of predetermined instructions to the sensor;and iii) the cloud-based micro-services system receives, in response tothe at least one sensor detecting a particular trigger event associatedwith a particular accessed electronic health record, particular accessedelectronic health record data and an identifier associated with theclinic health record system database from the at least one sensor forexecuting the set of predetermined instructions to automate a workflow.

According to an eighty-sixth aspect, the system of the eighty-fifthaspect or any other aspect, wherein the set of predeterminedinstructions comprise instructions for transmitting at least a portionof the particular accessed electronic health record data to a sponsororganization.

According to an eighty-seventh aspect, the system of the eighty-fifthaspect or any other aspect, wherein the clinic health record systemdatabase and the cloud-based micro-services system are physicallyseparated.

According to an eighty-eighth aspect, the system of the eighty-fifthaspect or any other aspect, wherein the set of predeterminedinstructions are initially configured by a user at the at least onecomputing system.

According to an eighty-ninth aspect, the system of the eighty-fifthaspect or any other aspect, wherein the workflow comprises transmittinga medical prescription to a pharmacy.

According to a ninetieth aspect, the system of the eighty-fifth aspector any other aspect, wherein the workflow comprises transmitting, to asponsor organization, a form populated with at least a portion of theparticular accessed electronic health record data based on thepredetermined instructions for automatically documenting a claim withthe sponsor organization

According to a ninety-first aspect, the system of the ninetieth aspector any other aspect, wherein automatically documenting a claim comprisescompleting a risk adjustment form.

According to a ninety-second aspect, the system of the ninetieth aspector any other aspect, wherein automatically documenting a claim comprisescompleting an insurance claim.

According to a ninety-third aspect, a computer-implemented method forautomating tasks in a workflow, comprising the steps of: A) in responseto at least one sensor monitoring a clinic health record system databaseat preconfigured intervals for detecting a trigger even corresponding toelectronic access to an electronic health record, receiving a requestfrom the at least one sensor at a cloud-based micro-services system, thecloud-based micro-services system operatively connected to the at leastone sensor and comprising at least one micro-services database includingelectronic health records received from at least one third-party system,and a set of predetermined instructions for responding to the triggerevent, the request requesting the set of predetermined instructions forresponding to the trigger event; B) transmitting the set ofpredetermined instructions to the at least one sensor; and C) receiving,in response to the at least one sensor detecting a particular triggerevent associated with a particular accessed electronic health record,particular accessed electronic health record data and an identifierassociated with the clinic health record system database from the atleast one sensor for executing the set of predetermined instructions toautomate a workflow.

According to a ninety-fourth aspect, the computer-implemented method ofthe ninety-third aspect or any other aspect, wherein the set ofpredetermined instructions comprise instructions for transmitting atleast a portion of the particular accessed electronic health record datato a sponsor organization.

According to a ninety-fifth aspect, the computer-implemented method ofthe ninety-third aspect or any other aspect, wherein the clinic healthrecord system database and the cloud-based micro-services system arephysically separated.

According to a ninety-sixth aspect, the computer-implemented method ofthe ninety-third aspect or any other aspect, wherein the set ofpredetermined instructions are initially configured by a user at the atleast one computing system.

According to a ninety-seventh aspect, the computer-implemented method ofthe ninety-third aspect or any other aspect, wherein the workflowcomprises transmitting a medical prescription to a pharmacy.

According to a ninety-eight aspect, the computer-implemented method ofthe ninety-third aspect or any other aspect, wherein the workflowcomprises transmitting, to a sponsor organization, a form populated withat least a portion of the particular accessed electronic health recorddata based on the predetermined instructions for automaticallydocumenting a claim with the sponsor organization

According to a ninety-ninth aspect, the computer-implemented method ofthe ninety-eighth aspect or any other aspect, wherein automaticallydocumenting a claim comprises completing a risk adjustment form.

According to a hundredth aspect, the computer-implemented method of theninety-eighth aspect or any other aspect, wherein automaticallydocumenting a claim comprises completing an insurance claim.

CONCLUSION

The foregoing description of the exemplary embodiments has beenpresented only for the purposes of illustration and description and isnot intended to be exhaustive or to limit the inventions to the preciseforms disclosed. Many modifications and variations are possible in lightof the above teaching.

The embodiments were chosen and described in order to explain theprinciples of the inventions and their practical application so as toenable others skilled in the art to utilize the inventions and variousembodiments and with various modifications as are suited to theparticular use contemplated. Alternative embodiments will becomeapparent to those skilled in the art to which the present inventionspertain without departing from their spirit and scope. Accordingly, thescope of the present inventions is defined by the appended claims ratherthan the foregoing description and the exemplary embodiments describedtherein.

What is claimed is:
 1. A system for reconciling healthcare informationbetween disparate sources, comprising: a surfacing application forpresenting health record related alerts on a display in conjunction withelectronic health records, the surfacing application operativelyconnected to at least one computing system at a healthcare clinicincluding the display; at least one software-defined patient contextsensor operatively connected to the at least one computing system,wherein the at least one software-defined patient context sensor isconfigured to detect, via screen scraping the display, a data accesstrigger event corresponding to the at least one computing systemsurfacing electronic health records associated with a particular set ofpatients at the display; at least one software-defined third-partycontext sensor operatively connected to a remote data repository andconfigured to poll the remote data repository for third-party analyticdata from a sponsor system, the third-party analytic data comprisinghealthcare information corresponding to at least a subset of theparticular set of patients and wherein the healthcare information isstored in a first particular format based on the remote data repository;and a remote micro-services system operatively connected to the at leastone software-defined third-party context sensor and the at least onesoftware-defined patient context sensor, the remote micro-servicessystem comprising at least one micro-services database and one or moreprocessors configured for: receiving the third-party analytic datacomprising the healthcare information from the at least onesoftware-defined third-party context sensor; associating anidentification number with each patient included in the subset of theparticular set of patients; in response to the at least onesoftware-defined patient context sensor detecting, via screen scrapingthe display, a particular data access trigger event corresponding to theat least one computing system surfacing at the display a particularelectronic health record of at least one of the patients included in thesubset of the particular set of patients, receiving accessed chart datafrom the at least one software-defined patient context sensor, whereinthe received accessed chart data is stored in a second particular formatbased on the at least one computing system, the accessed chart datacorresponding to the at least one patient's electronic health record;transforming the healthcare information stored in the first particularformat into the second particular format; determining healthcare gapinformation between the received accessed chart data and the healthcareinformation with a corresponding identification number, wherein thehealthcare gap information comprises healthcare data other than theaccessed chart data; and transmitting the healthcare gap information tothe surfacing application, wherein the surfacing application modifiesthe display of the at least one computing system by surfacing thehealthcare gap information, wherein surfacing the healthcare gapinformation comprises: surfacing an alert selectable by a user at thesurfacing application and comprising a partial record of the healthcaregap information, the partial record including one or more indicatorscorresponding to one or more portions of a complete record of thehealthcare gap information, wherein the complete record of thehealthcare gap information is in an unsurfaced state while the alert issurfaced; and in response to the user selecting the alert, surfacing thecomplete record of the healthcare gap information, wherein the completerecord of the healthcare gap information replaces the alert on thedisplay.
 2. The system of claim 1, wherein the at least onesoftware-defined patient context sensor receives a list of identifiersfrom the remote micro-services system prior to detecting the particulardata access trigger event.
 3. The system of claim 2, wherein the list ofidentifiers is extracted from the third-party analytic data of thesponsor.
 4. The system of claim 3, wherein the sponsor is a healthcareinsurance provider.
 5. The system of claim 1, wherein the at least onemicro-services database stores the health records in a normalizedcanonical format.
 6. The system of claim 1, wherein the at least onemicro-services database is a NoSQL Key-Value database.
 7. The system ofclaim 1, wherein prior to transmitting the healthcare gap information tothe at least one computing system, the healthcare gap information isstored in a context table at the remote micro-services system, whereinthe context table is accessible by one or more additional computingsystems at healthcare clinics associated with the at least one patient.8. The system of claim 1, wherein the healthcare gap information istransmitted to the at least one computing system via a micro-servicesapplication programming interface.
 9. A method for reconcilinghealthcare information between disparate sources, the method comprisingthe steps of: detecting, via at least one software-defined patientcontext sensor, a data access trigger event corresponding to at leastone computing system surfacing onto a display at the at least onecomputing system one or more electronic health records, the at least onesoftware-defined patient context sensor operatively connected to the atleast one computing system, wherein the at least one software-definedpatient context sensor detects the data access trigger event via screenscraping the display; polling a remote data repository via at least onesoftware-defined third-party context sensor operatively connected to theremote data repository for third-party analytic data from a sponsorsystem, the third-party analytic data comprising healthcare informationcorresponding to at least a subset of a particular set of patients andwherein the healthcare information is stored in a first particularformat based on the remote data repository; and receiving at a remotemicro-services system the third-party analytic data comprising thehealthcare information from the software-defined third-party contextsensor, the remote micro-services system operatively connected to the atleast one software-defined third-party context sensor and the at leastone software-defined patient context sensor, the remote micro-servicessystem comprising at least one micro-services database and one or moreprocessors configured for: associating an identification number witheach patient included in the subset of the particular set of patients;in response to the at least one software-defined patient context sensordetecting, via screen scraping the display, a particular data accesstrigger event corresponding to the at least one computing systemsurfacing at the display a particular electronic health record of atleast one of the patients included in the subset of the particular setof patients, receiving accessed chart data from the at least onesoftware-defined patient context sensor, wherein the received accessedchart data is stored in a second particular format based on the at leastone computing system, the accessed chart data corresponding to the atleast one patient's electronic health record; transforming thehealthcare information stored in the first particular format into thesecond particular format; determining healthcare gap information betweenthe received accessed chart data and the healthcare information with acorresponding identification number, wherein the healthcare gapinformation comprises healthcare data other than the accessed chartdata; and transmitting the healthcare gap information to a surfacingapplication installed on the at least one computing system, wherein thesurfacing application modifies the display of the at least one computingsystem by surfacing the healthcare gap information, wherein surfacingthe healthcare gap information comprises: surfacing an alert selectableby a user at the surfacing application and comprising a partial recordof the healthcare gap information, the partial record including one ormore indicators corresponding to one or more portions of a completerecord of the healthcare gap information, wherein the complete record ofthe healthcare gap information is in an unsurfaced state while the alertis surfaced; and in response to the user selecting the alert, surfacingthe complete record of the healthcare gap information, wherein thecomplete record of the healthcare gap information replaces the alert onthe display.
 10. The method of claim 9, wherein the at least onesoftware-defined patient context sensor receives a list of identifiersfrom the remote micro-services system prior to detecting the particulardata access trigger event.
 11. The method of claim 10, wherein the listof identifiers is extracted from the third-party analytic data of thesponsor.
 12. The method of claim 11, wherein the sponsor is a healthcareinsurance provider.
 13. The method of claim 9, wherein the at least onemicro-services database stores the health records in a normalizedcanonical format.
 14. The method of claim 9, wherein the at least onemicro-services database is a NoSQL Key-Value database.
 15. The method ofclaim 9, wherein prior to transmitting the healthcare gap information tothe at least one computing system, the healthcare gap information isstored in a context table at the remote micro-services system, whereinthe context table is accessible by one or more additional computingsystems at healthcare clinics associated with the particular patient.16. The method of claim 9, wherein the healthcare gap information istransmitted to the at least one computing system via a micro-servicesapplication programming interface.